Healthcare Provider Details

I. General information

NPI: 1992886022
Provider Name (Legal Business Name): CHRIS PHILLIPS ATC, CSCS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/17/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 F ST NW WASHINGTON CAPITALS
WASHINGTON DC
20004-1605
US

IV. Provider business mailing address

9720 TARA DR
DUNKIRK MD
20754-3004
US

V. Phone/Fax

Practice location:
  • Phone: 949-690-1277
  • Fax:
Mailing address:
  • Phone: 949-690-1277
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: