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General NPI Number Information
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NPI Number | 1760628002
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Entity Type | Individual
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Provider Name | CHRISTOPHER MICHAEL DISISTO SR. PT DPT
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Gender | Male
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Dates
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Enumeration Date | 12/16/2008
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Last Update Date | 12/17/2024
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Provider Practice Location Address
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Address Line | 141 E CHURCH ST STE N
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City | BATESBURG LEESVILLE
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State | SC
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Zip | 29070-7066
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Country | US
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Telephone | 803-532-3335
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Fax | 803-532-3337
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Provider Business Mailing Address
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Address Line | 141 E CHURCH ST STE N
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City | BATESBURG LEESVILLE
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State | SC
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Zip | 29070-7066
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Country | US
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Telephone | 803-532-3335
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Fax | 803-532-3337
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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 | 2251X0800X
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Taxonomy Name | Orthopedic Physical Therapist
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License Number | 10902
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License Number State | SC
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