Provider Demographics
NPI:1508822909
Name:TUTT, CHRISTOPHER GEORGE (MPT)
Entity Type:Individual
Prefix:MR
First Name:CHRISTOPHER
Middle Name:GEORGE
Last Name:TUTT
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1480 NE VILAGE ST
Mailing Address - Street 2:
Mailing Address - City:FAIRVIEW
Mailing Address - State:OR
Mailing Address - Zip Code:97024
Mailing Address - Country:US
Mailing Address - Phone:503-489-1781
Mailing Address - Fax:503-489-1650
Practice Address - Street 1:25500 SE STARK ST
Practice Address - Street 2:SUITE 103
Practice Address - City:GRESHAM
Practice Address - State:OR
Practice Address - Zip Code:97030-3331
Practice Address - Country:US
Practice Address - Phone:503-328-0222
Practice Address - Fax:503-328-0223
Is Sole Proprietor?:No
Enumeration Date:2006-04-25
Last Update Date:2008-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR2725225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR000130OtherOMAP
ORR114779Medicare PIN
WAG8802660Medicare PIN
ORR114778Medicare PIN
WAG8865695Medicare PIN
WAG8862712Medicare PIN
OR000130OtherOMAP