Healthcare Provider Details

I. General information

NPI: 1295765394
Provider Name (Legal Business Name): CHRISTOPHER CARL MIZER MS, ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/04/2006
Last Update Date: 06/27/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

920 N HAMILTON RD STE 600
GAHANNA OH
43230-1757
US

IV. Provider business mailing address

1739 HARRISON POND DR
NEW ALBANY OH
43054-8885
US

V. Phone/Fax

Practice location:
  • Phone: 614-366-5866
  • Fax: 614-293-7540
Mailing address:
  • Phone: 614-855-3428
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberAT-554
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: