Provider Demographics
NPI:1689746620
Name:GRIDLEY, CHRISTOPHER I (MPT)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:I
Last Name:GRIDLEY
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 1:1317 N BRIGHTLEAF BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:SMITHFIELD
Mailing Address - State:NC
Mailing Address - Zip Code:27577-7267
Mailing Address - Country:US
Mailing Address - Phone:919-300-5040
Mailing Address - Fax:919-438-0893
Practice Address - Street 1:1317 N BRIGHTLEAF BLVD STE A
Practice Address - Street 2:
Practice Address - City:SMITHFIELD
Practice Address - State:NC
Practice Address - Zip Code:27577-7267
Practice Address - Country:US
Practice Address - Phone:919-300-5040
Practice Address - Fax:919-438-0893
Is Sole Proprietor?:No
Enumeration Date:2006-11-14
Last Update Date:2021-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP135532251X0800X, 2251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI50652901Medicaid
HI0000235085OtherHMSA
HI50652901Medicaid