Provider Demographics
NPI:1043393135
Name:MAGNUSON, CHRISTOPHER C (PT)
Entity Type:Individual
Prefix:MR
First Name:CHRISTOPHER
Middle Name:C
Last Name:MAGNUSON
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:49 BARTON RD
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06460-6702
Mailing Address - Country:US
Mailing Address - Phone:860-565-1089
Mailing Address - Fax:860-665-4581
Practice Address - Street 1:400 MAIN ST
Practice Address - Street 2:MEDICAL DEPT., MS 124-10
Practice Address - City:EAST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06108-0968
Practice Address - Country:US
Practice Address - Phone:860-565-1089
Practice Address - Fax:860-665-4581
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT006754225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist