Healthcare Provider Details

I. General information

NPI: 1487190468
Provider Name (Legal Business Name): CHRISTOPHER HEASLIP DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/13/2017
Last Update Date: 01/13/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8015 FRANKFORD AVE
PHILADELPHIA PA
19136-2736
US

IV. Provider business mailing address

811 ADDISON ST APT B
PHILADELPHIA PA
19147-1302
US

V. Phone/Fax

Practice location:
  • Phone: 215-338-8900
  • Fax: 215-338-8923
Mailing address:
  • Phone: 724-801-8095
  • Fax: 724-801-8147

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT-025516
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: