Healthcare Provider Details

I. General information

NPI: 1578533550
Provider Name (Legal Business Name): CHRISTOPHER S FICKE P.T.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/24/2006
Last Update Date: 06/15/2023
Certification Date: 06/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 24TH ST
FORT LEE VA
23801-1716
US

IV. Provider business mailing address

700 24TH ST
FORT LEE VA
23801-1716
US

V. Phone/Fax

Practice location:
  • Phone: 804-734-9200
  • Fax: 804-734-9562
Mailing address:
  • Phone: 804-732-9200
  • Fax: 843-743-7521

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number6015
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: