Provider Demographics
NPI:1174826325
Name:GREENLEAF, CHRISTOPHER DAVID (PHD, LAT,ATC, CSCS)
Entity Type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:DAVID
Last Name:GREENLEAF
Suffix:
Gender:M
Credentials:PHD, LAT,ATC, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1900 AVENUE I SITE 107R
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:77341-2176
Mailing Address - Country:US
Mailing Address - Phone:936-294-2649
Mailing Address - Fax:
Practice Address - Street 1:1900 AVENUE I SITE 107R
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:TX
Practice Address - Zip Code:77341-2176
Practice Address - Country:US
Practice Address - Phone:936-294-2649
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-12-09
Last Update Date:2022-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AT77842255A2300X
NE1197024102255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer