Provider Demographics
NPI:1619040649
Name:DEANS, CHRISTOPHER B (PT)
Entity Type:Individual
Prefix:MR
First Name:CHRISTOPHER
Middle Name:B
Last Name:DEANS
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5451 ROBINSON ROAD EXT
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39204-4138
Mailing Address - Country:US
Mailing Address - Phone:601-371-5257
Mailing Address - Fax:601-371-9986
Practice Address - Street 1:5451 ROBINSON ROAD EXT
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39204-4138
Practice Address - Country:US
Practice Address - Phone:601-371-5257
Practice Address - Fax:601-371-9986
Is Sole Proprietor?:No
Enumeration Date:2006-11-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSPT1645225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS04784517Medicaid