Provider Demographics
NPI:1396819017
Name:HAREN, CHRISTOPHER RAY (MSPT)
Entity Type:Individual
Prefix:MR
First Name:CHRISTOPHER
Middle Name:RAY
Last Name:HAREN
Suffix:
Gender:M
Credentials:MSPT
Other - Prefix:
Other - First Name:
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Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:350 NEW FIDELITY CT
Mailing Address - Street 2:
Mailing Address - City:GARNER
Mailing Address - State:NC
Mailing Address - Zip Code:27529-2665
Mailing Address - Country:US
Mailing Address - Phone:919-258-2714
Mailing Address - Fax:
Practice Address - Street 1:501 CHURCH ST NE
Practice Address - Street 2:SUITE 105
Practice Address - City:VIENNA
Practice Address - State:VA
Practice Address - Zip Code:22180-4734
Practice Address - Country:US
Practice Address - Phone:703-938-8585
Practice Address - Fax:703-938-8602
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-17
Last Update Date:2019-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305204315225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist