Provider Demographics
NPI:1245209659
Name:INGERSOLL, CHRISTOPHER DANIEL (PHD, ATC, VATL)
Entity Type:Individual
Prefix:PROF
First Name:CHRISTOPHER
Middle Name:DANIEL
Last Name:INGERSOLL
Suffix:
Gender:M
Credentials:PHD, ATC, VATL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 EMMET ST S
Mailing Address - Street 2:PO BOX 400407
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22903-2455
Mailing Address - Country:US
Mailing Address - Phone:434-924-6187
Mailing Address - Fax:434-924-1389
Practice Address - Street 1:210 EMMET ST S
Practice Address - Street 2:SUITE 203
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22903-2455
Practice Address - Country:US
Practice Address - Phone:434-924-6187
Practice Address - Fax:434-924-1389
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01260004352255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer