Healthcare Provider Details

I. General information

NPI: 1396171930
Provider Name (Legal Business Name): CHRISTOPHER GARRITY
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2013
Last Update Date: 09/14/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

820 S DAMEN AVE
CHICAGO IL
60612-3728
US

IV. Provider business mailing address

PO BOX 693
WHITING IN
46394-0693
US

V. Phone/Fax

Practice location:
  • Phone: 312-569-8387
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code227800000X
TaxonomyCertified Respiratory Therapist
License Number194009394
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: