MEDICARE: MR. CHRISTIAN CO PT

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	2305006483	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2305006483	OTHER	VA	STATE OF VIRGINIA

General Provider Information

NPI Number	:	1700337425
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. CHRISTIAN CO PT

Provider Business Mailing Address
First Line	:	12625A LEE HWY
Second Line	:
City	:	WASHINGTON
State	:	VA
Zip	:	22747-1931
Country	:	US
Telephone Number	:	540-987-9390
Fax Number	:	540-987-9392

Provider Business Practice Location Address
First Line	:	12625A LEE HWY
Second Line	:
City	:	WASHINGTON
State	:	VA
Zip	:	22747-1931
Country	:	US
Telephone Number	:	540-987-9390
Fax Number	:	540-987-9392

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

Provider Enumeration Date	:	10/18/2016
Last Update Date	:	10/18/2016

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Directions to “ MR. CHRISTIAN CO PT” Practice Location

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