Provider Demographics
NPI:1710254065
Name:PANEPUCCI, CHRISTOPHER J (DPT)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:J
Last Name:PANEPUCCI
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7277 SMITHS MILL RD STE 100
Mailing Address - Street 2:
Mailing Address - City:NEW ALBANY
Mailing Address - State:OH
Mailing Address - Zip Code:43054-8195
Mailing Address - Country:US
Mailing Address - Phone:614-221-6331
Mailing Address - Fax:614-221-9042
Practice Address - Street 1:7277 SMITHS MILL RD STE 100
Practice Address - Street 2:
Practice Address - City:NEW ALBANY
Practice Address - State:OH
Practice Address - Zip Code:43054-8195
Practice Address - Country:US
Practice Address - Phone:614-221-6331
Practice Address - Fax:614-221-9042
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-30
Last Update Date:2022-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT013073225100000X
OHPT.0130732251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0071702Medicaid
OHH056121Medicare PIN
OHH056120Medicare PIN