Healthcare Provider Details

I. General information

NPI: 1255910600
Provider Name (Legal Business Name): CHRISTOPHER GREGORY WESDOCK PT, DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/05/2021
Last Update Date: 06/06/2022
Certification Date: 06/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 MEDICAL CAMPUS DR NW STE 204
SUPPLY NC
28462-4094
US

IV. Provider business mailing address

9359 CASSADINE CT
LELAND NC
28451-1860
US

V. Phone/Fax

Practice location:
  • Phone: 910-755-5861
  • Fax:
Mailing address:
  • Phone: 804-517-6216
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2305214298
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberP20545
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: