Provider Demographics
NPI:1396844775
Name:HEADRICK, CHRISTOPHER (PT)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:
Last Name:HEADRICK
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6910 DOUGLAS BLVD
Mailing Address - Street 2:SUITE D
Mailing Address - City:GRANITE BAY
Mailing Address - State:CA
Mailing Address - Zip Code:95746
Mailing Address - Country:US
Mailing Address - Phone:916-791-5011
Mailing Address - Fax:916-791-3211
Practice Address - Street 1:6910 DOUGLAS BLVD
Practice Address - Street 2:SUITE D
Practice Address - City:GRANITE BAY
Practice Address - State:CA
Practice Address - Zip Code:95746
Practice Address - Country:US
Practice Address - Phone:916-791-5011
Practice Address - Fax:916-791-3211
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-21
Last Update Date:2007-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT27707225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0PT277071Medicare PIN