Provider Demographics
NPI:1699008920
Name:WAMPLER, CHRISTOPHER ALLEN (PTA)
Entity Type:Individual
Prefix:MR
First Name:CHRISTOPHER
Middle Name:ALLEN
Last Name:WAMPLER
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 1:6868 W ODESSA WAY
Mailing Address - Street 2:
Mailing Address - City:MC CORDSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46055-9476
Mailing Address - Country:US
Mailing Address - Phone:317-491-0463
Mailing Address - Fax:
Practice Address - Street 1:8549 MADISON AVE
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46227-6153
Practice Address - Country:US
Practice Address - Phone:317-881-9164
Practice Address - Fax:317-887-4060
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-18
Last Update Date:2009-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN06001408A225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant