Provider Demographics
NPI:1083806947
Name:PETRIE, CHRISTOPHER JOHN (AP)
Entity Type:Individual
Prefix:MR
First Name:CHRISTOPHER
Middle Name:JOHN
Last Name:PETRIE
Suffix:
Gender:M
Credentials:AP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2201 NE 66TH ST
Mailing Address - Street 2:#1305
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33308-1234
Mailing Address - Country:US
Mailing Address - Phone:954-415-7309
Mailing Address - Fax:
Practice Address - Street 1:2201 NE 66TH ST
Practice Address - Street 2:#1305
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33308-1234
Practice Address - Country:US
Practice Address - Phone:954-415-7309
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-15
Last Update Date:2007-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLA.P.2175171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist