Healthcare Provider Details

I. General information

NPI: 1528443918
Provider Name (Legal Business Name): CHRIS COMRIE ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2015
Last Update Date: 11/05/2023
Certification Date: 11/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8 AUTUMN LEAVES DR
LAKE SAINT LOUIS MO
63367-6436
US

IV. Provider business mailing address

8 AUTUMN LEAVES DR
LAKE SAINT LOUIS MO
63367-6436
US

V. Phone/Fax

Practice location:
  • Phone: 314-495-5748
  • Fax:
Mailing address:
  • Phone: 314-495-5748
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) Physician
License Number0001464
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: