MEDICARE: DR. CHRISTOPHER JOHN SHIELDS 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	2251X0800X	Orthopedic Physical Therapist	1188550	TX

General Provider Information

NPI Number	:	1639704117
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHRISTOPHER JOHN SHIELDS DPT

Provider Business Mailing Address
First Line	:	404 MYRA ST
Second Line	:
City	:	FRIENDSWOOD
State	:	TX
Zip	:	77546-4465
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6400 FANNIN ST STE 1620
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77030-1509
Country	:	US
Telephone Number	:	713-704-9602
Fax Number	:

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

Provider Enumeration Date	:	03/05/2020
Last Update Date	:	03/05/2020

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