Provider Demographics
NPI:1639515356
Name:ELMORE, CHRISTOPHER DERIK (PT, DPT)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:DERIK
Last Name:ELMORE
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8823 PRODUCTION LN
Mailing Address - Street 2:
Mailing Address - City:OOLTEWAH
Mailing Address - State:TN
Mailing Address - Zip Code:37363-6511
Mailing Address - Country:US
Mailing Address - Phone:423-238-7217
Mailing Address - Fax:423-362-8684
Practice Address - Street 1:22576 RHEA COUNTY HWY
Practice Address - Street 2:STE 7
Practice Address - City:SPRING CITY
Practice Address - State:TN
Practice Address - Zip Code:37381-5393
Practice Address - Country:US
Practice Address - Phone:423-362-5884
Practice Address - Fax:423-365-5231
Is Sole Proprietor?:No
Enumeration Date:2013-05-21
Last Update Date:2016-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN9562225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist