Provider Demographics
NPI:1538649488
Name:WILSON, CHRISTOPHER NATHAN (PTA)
Entity Type:Individual
Prefix:MR
First Name:CHRISTOPHER
Middle Name:NATHAN
Last Name:WILSON
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8000 OFFENHAUSER DR APT 12A
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89511-1390
Mailing Address - Country:US
Mailing Address - Phone:775-336-7739
Mailing Address - Fax:
Practice Address - Street 1:9990 DOUBLE R BLVD STE 200
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89521-4833
Practice Address - Country:US
Practice Address - Phone:775-348-8800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-20
Last Update Date:2018-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVA1147225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant