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NPI Code Detail

MEDICARE: MR. CHRISTOPHER JOSEPH HEARD ATC

MEDICARE: MR. CHRISTOPHER JOSEPH HEARD ATC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12255A2300XAthletic Trainer

General Provider Information

NPI Number : 1225071889
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. CHRISTOPHER JOSEPH HEARD ATC
Provider Business Mailing Address
First Line : 2120 ELM ST
Second Line :
City : BUTTE
State : MT
Zip : 59701-4906
Country : US
Telephone Number : 406-491-3197
Fax Number : 406-723-2544
Provider Business Practice Location Address
First Line : 400 S CLARK ST
Second Line : MONTANA SPORTS MEDICINE
City : BUTTE
State : MT
Zip : 59701-2328
Country : US
Telephone Number : 406-723-2549
Fax Number : 406-723-2544
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/13/2006
Last Update Date : 07/08/2007

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