Provider Demographics
NPI:1760494637
Name:SHAFF, CHRISTOPHER PATRICK (ATC)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:PATRICK
Last Name:SHAFF
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1212 STELLAR DR
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:IN
Mailing Address - Zip Code:46131-6903
Mailing Address - Country:US
Mailing Address - Phone:317-507-1454
Mailing Address - Fax:
Practice Address - Street 1:101 BRANIGIN BLVD
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:IN
Practice Address - Zip Code:46131-2623
Practice Address - Country:US
Practice Address - Phone:317-738-8125
Practice Address - Fax:317-738-8248
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-12
Last Update Date:2012-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN36000403A2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer