Provider Demographics
NPI:1407131352
Name:WADAS, KORBE CHRISTOPHER
Entity Type:Individual
Prefix:
First Name:KORBE
Middle Name:CHRISTOPHER
Last Name:WADAS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10108 BARRETT RD
Mailing Address - Street 2:
Mailing Address - City:CHEYENNE
Mailing Address - State:WY
Mailing Address - Zip Code:82009-8893
Mailing Address - Country:US
Mailing Address - Phone:308-728-7297
Mailing Address - Fax:
Practice Address - Street 1:1330 PRAIRIE AVE
Practice Address - Street 2:
Practice Address - City:CHEYENNE
Practice Address - State:WY
Practice Address - Zip Code:82009-4842
Practice Address - Country:US
Practice Address - Phone:307-778-8997
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-11
Last Update Date:2011-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYPTA-0722225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant