Provider Demographics
NPI:1245418003
Name:CHRISTOPHER SHOWALTER PT PC
Entity Type:Organization
Organization Name:CHRISTOPHER SHOWALTER PT PC
Other - Org Name:AUSTRALIAN PHYSIOTHERAPY CENTERS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHRIS
Authorized Official - Middle Name:R
Authorized Official - Last Name:SHOWALTER
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:631-298-5367
Mailing Address - Street 1:PO BOX 1244
Mailing Address - Street 2:
Mailing Address - City:CUTCHOGUE
Mailing Address - State:NY
Mailing Address - Zip Code:11935-0883
Mailing Address - Country:US
Mailing Address - Phone:631-298-5367
Mailing Address - Fax:631-298-3810
Practice Address - Street 1:1750 YORK AVE
Practice Address - Street 2:4TH FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10128
Practice Address - Country:US
Practice Address - Phone:212-369-5980
Practice Address - Fax:631-298-3810
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-04
Last Update Date:2008-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012464174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQOW052Medicare PIN