Healthcare Provider Details

I. General information

NPI: 1851354146
Provider Name (Legal Business Name): CHRISTOPHER JOHN MAYOTT PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/09/2006
Last Update Date: 08/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1081 CHAPEL FARM RD
CLIFTON TN
38425-4238
US

IV. Provider business mailing address

PO BOX 215
LINDEN TN
37096-0215
US

V. Phone/Fax

Practice location:
  • Phone: 954-609-4797
  • Fax:
Mailing address:
  • Phone: 954-609-4797
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number15565
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number13610
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number8713
License Number StateGA
# 4
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number8264
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: