MEDICARE: CHRISTOPHER ALLEN LONG PT, DPT

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
1	225100000X	Physical Therapist		GA
2	225100000X	Physical Therapist	18621	NC

General Provider Information

NPI Number	:	1235675828
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTOPHER ALLEN LONG PT, DPT

Provider Business Mailing Address
First Line	:	6397 LEE HWY STE 300
Second Line	:
City	:	CHATTANOOGA
State	:	TN
Zip	:	37421-4915
Country	:	US
Telephone Number	:	423-682-8840
Fax Number	:	423-602-2028

Provider Business Practice Location Address
First Line	:	2230 PARK RD STE 104
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28203-6664
Country	:	US
Telephone Number	:	704-919-1280
Fax Number	:	704-919-0580

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/06/2017
Last Update Date	:	03/27/2019

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