=====================================================
General NPI Number Information
=====================================================
NPI Number | 1194424465
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | 3C PT PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/27/2023
-----------------------------------------------------
Last Update Date | 02/27/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7581 BUSTER PL
-----------------------------------------------------
City | AMARILLO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 79119-7453
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 806-683-1534
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7405 MEMPHIS AVE
-----------------------------------------------------
City | AMARILLO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 79118-1132
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 806-683-1534
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/PROVIDER
-----------------------------------------------------
Name | CHRISTOPHER CHASE CHRISTY
-----------------------------------------------------
Credential | DPT
-----------------------------------------------------
Telephone | 806-683-1534
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QP2000X
-----------------------------------------------------
Taxonomy Name | Physical Therapy Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------