Healthcare Provider Details

I. General information

NPI: 1972524114
Provider Name (Legal Business Name): CHRISTOPHER SCOTT BRINK PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/22/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 COLLINS RD NE BLDG 154-100
CEDAR RAPIDS IA
52498-0001
US

IV. Provider business mailing address

400 COLLINS RD NE BLDG 154-100
CEDAR RAPIDS IA
52498-0001
US

V. Phone/Fax

Practice location:
  • Phone: 319-295-8899
  • Fax: 319-295-8833
Mailing address:
  • Phone: 319-295-8899
  • Fax: 319-295-8833

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number03755
License Number StateIA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier38398
Identifier TypeOTHER
Identifier StateIA
Identifier IssuerBCBS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: