Provider Demographics
NPI:1477041903
Name:CHRISTIAN, CHLOE' (PTA)
Entity Type:Individual
Prefix:
First Name:CHLOE'
Middle Name:
Last Name:CHRISTIAN
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3316 WARWICK DR
Mailing Address - Street 2:
Mailing Address - City:JAMESTOWN
Mailing Address - State:NC
Mailing Address - Zip Code:27282-9074
Mailing Address - Country:US
Mailing Address - Phone:336-707-8553
Mailing Address - Fax:
Practice Address - Street 1:620 HEATHWOOD DR
Practice Address - Street 2:
Practice Address - City:ALBEMARLE
Practice Address - State:NC
Practice Address - Zip Code:28001-8604
Practice Address - Country:US
Practice Address - Phone:704-983-2686
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-30
Last Update Date:2018-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC6493225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant