Provider Demographics
NPI:1578070413
Name:LAMB, CHRISTOPHER BRIAN (PTA)
Entity Type:Individual
Prefix:MR
First Name:CHRISTOPHER
Middle Name:BRIAN
Last Name:LAMB
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 1:1406 FAYETTEVILLE DR
Mailing Address - Street 2:
Mailing Address - City:SPRING HILL
Mailing Address - State:FL
Mailing Address - Zip Code:34609-4923
Mailing Address - Country:US
Mailing Address - Phone:904-434-0515
Mailing Address - Fax:
Practice Address - Street 1:705 TRANCAS ST
Practice Address - Street 2:
Practice Address - City:NAPA
Practice Address - State:CA
Practice Address - Zip Code:94558-3014
Practice Address - Country:US
Practice Address - Phone:707-255-6060
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-31
Last Update Date:2017-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPTA27256225200000X
CAPTA49044225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant