MEDICARE: CHRISTOPHER CHAD WOMBLE 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	1280617	TX

General Provider Information

NPI Number	:	1457703969
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTOPHER CHAD WOMBLE DPT

Provider Business Mailing Address
First Line	:	1900 LONG PRAIRIE RD
Second Line	:	SUITE 104
City	:	FLOWER MOUND
State	:	TX
Zip	:	75022
Country	:	US
Telephone Number	:	972-724-2400
Fax Number	:	972-724-2495

Provider Business Practice Location Address
First Line	:	4364 HERITAGE TRACE PKWY
Second Line	:	SUITE 108
City	:	FORT WORTH
State	:	TX
Zip	:	76244-9106
Country	:	US
Telephone Number	:	817-379-1400
Fax Number	:	817-379-1404

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

Provider Enumeration Date	:	07/08/2016
Last Update Date	:	08/02/2016

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