Provider Demographics
NPI:1801858980
Name:SPALDING, CHRIS (ATC, PTA)
Entity Type:Individual
Prefix:MR
First Name:CHRIS
Middle Name:
Last Name:SPALDING
Suffix:
Gender:M
Credentials:ATC, PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1331
Mailing Address - Street 2:
Mailing Address - City:PEARL CITY
Mailing Address - State:HI
Mailing Address - Zip Code:96782-8331
Mailing Address - Country:US
Mailing Address - Phone:619-805-5435
Mailing Address - Fax:
Practice Address - Street 1:2001 VICTOR WHARF ACCESS RD
Practice Address - Street 2:NSWG-3 SPORTS MEDICINE
Practice Address - City:PEARL CITY
Practice Address - State:HI
Practice Address - Zip Code:96782-3400
Practice Address - Country:US
Practice Address - Phone:619-805-5435
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-04
Last Update Date:2014-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAT 3785225200000X
CA8402632255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
No225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant