Provider Demographics
NPI:1437559887
Name:WOLBERT, CHRISTOPHER DALE
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:DALE
Last Name:WOLBERT
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 1:1975 W ELK AVE
Mailing Address - Street 2:STE. 1
Mailing Address - City:ELIZABETHTON
Mailing Address - State:TN
Mailing Address - Zip Code:37643-3787
Mailing Address - Country:US
Mailing Address - Phone:423-543-0073
Mailing Address - Fax:423-543-1277
Practice Address - Street 1:1975 W ELK AVE
Practice Address - Street 2:STE. 1
Practice Address - City:ELIZABETHTON
Practice Address - State:TN
Practice Address - Zip Code:37643-3787
Practice Address - Country:US
Practice Address - Phone:423-543-0073
Practice Address - Fax:423-543-1277
Is Sole Proprietor?:No
Enumeration Date:2014-09-03
Last Update Date:2015-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501016941225100000X
TN10277225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist