Healthcare Provider Details

I. General information

NPI: 1902728975
Provider Name (Legal Business Name): CHRISTOPHER SOOTHILL LMBT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/29/2026
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

936 W 4TH ST STE 200
WINSTON SALEM NC
27101-2564
US

IV. Provider business mailing address

132 FOREST GLADE RD
WINSTON SALEM NC
27107-6014
US

V. Phone/Fax

Practice location:
  • Phone: 336-473-0368
  • Fax:
Mailing address:
  • Phone: 336-473-0368
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number9156
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: