Healthcare Provider Details

I. General information

NPI: 1265073423
Provider Name (Legal Business Name): CHRISTOPHER DYBA DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/30/2019
Last Update Date: 04/30/2020
Certification Date: 04/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6034 HEATH VALLEY RD
CHARLOTTE NC
28210-4352
US

IV. Provider business mailing address

6034 HEATH VALLEY RD
CHARLOTTE NC
28210-4352
US

V. Phone/Fax

Practice location:
  • Phone: 785-249-2350
  • Fax:
Mailing address:
  • Phone: 785-249-2350
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberP15195
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: