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General NPI Number Information
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NPI Number | 1295765394
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Entity Type | Individual
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Provider Name | CHRISTOPHER CARL MIZER MS, ATC
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Gender | Male
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Dates
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Enumeration Date | 07/04/2006
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Last Update Date | 06/27/2011
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Provider Practice Location Address
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Address Line | 920 N HAMILTON RD STE 600
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City | GAHANNA
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State | OH
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Zip | 43230-1757
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Country | US
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Telephone | 614-366-5866
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Fax | 614-293-7540
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Provider Business Mailing Address
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Address Line | 1739 HARRISON POND DR
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City | NEW ALBANY
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State | OH
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Zip | 43054-8885
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Country | US
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Telephone | 614-855-3428
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | AT-554
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License Number State | OH
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