Provider Demographics
NPI:1073788766
Name:HUMPHREY, CHRISTOPHER DAVID (LMP)
Entity Type:Individual
Prefix:MR
First Name:CHRISTOPHER
Middle Name:DAVID
Last Name:HUMPHREY
Suffix:
Gender:M
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8308 E MILL PLAIN BLVD
Mailing Address - Street 2:102
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98664
Mailing Address - Country:US
Mailing Address - Phone:360-694-1118
Mailing Address - Fax:360-694-1979
Practice Address - Street 1:8308 E MILL PLAIN BLVD
Practice Address - Street 2:102
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98664
Practice Address - Country:US
Practice Address - Phone:360-694-1118
Practice Address - Fax:360-694-1979
Is Sole Proprietor?:No
Enumeration Date:2008-04-24
Last Update Date:2008-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60000913225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist