Healthcare Provider Details

I. General information

NPI: 1245209659
Provider Name (Legal Business Name): CHRISTOPHER DANIEL INGERSOLL PHD, ATC, VATL
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/16/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 EMMET ST S SUITE 203
CHARLOTTESVILLE VA
22903-2455
US

IV. Provider business mailing address

210 EMMET ST S PO BOX 400407
CHARLOTTESVILLE VA
22903-2455
US

V. Phone/Fax

Practice location:
  • Phone: 434-924-6187
  • Fax: 434-924-1389
Mailing address:
  • Phone: 434-924-6187
  • Fax: 434-924-1389

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number0126000435
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: