Provider Demographics
NPI:1770632697
Name:WOOD, CHRISTOPHER PAUL (LMT)
Entity Type:Individual
Prefix:MR
First Name:CHRISTOPHER
Middle Name:PAUL
Last Name:WOOD
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2100 NE BROADWAY
Mailing Address - Street 2:SUITE 225
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97232-1569
Mailing Address - Country:US
Mailing Address - Phone:503-780-0358
Mailing Address - Fax:
Practice Address - Street 1:2100 NE BROADWAY
Practice Address - Street 2:SUITE 225
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97232-1569
Practice Address - Country:US
Practice Address - Phone:503-780-0358
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-09
Last Update Date:2011-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR10470225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist