Healthcare Provider Details

I. General information

NPI: 1497743173
Provider Name (Legal Business Name): CHRISTOPHER P DENNETT A.T.C., M.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/07/2005
Last Update Date: 10/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3303 SW BOND AVE CENTER FOR HEALTH & HEALING, OHSU, CH3T
PORTLAND OR
97239
US

IV. Provider business mailing address

6835 N WALL AVE
PORTLAND OR
97203-5631
US

V. Phone/Fax

Practice location:
  • Phone: 503-418-9470
  • Fax: 503-494-4360
Mailing address:
  • Phone: 503-961-4744
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberAT-AT-784654
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: