Provider Demographics
NPI:1821056235
Name:CHRISTY, KENNETH (ATC)
Entity Type:Individual
Prefix:MR
First Name:KENNETH
Middle Name:
Last Name:CHRISTY
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 1:2012 NARBERTH AVE
Mailing Address - Street 2:
Mailing Address - City:HADDON HEIGHTS
Mailing Address - State:NJ
Mailing Address - Zip Code:08035-1020
Mailing Address - Country:US
Mailing Address - Phone:856-546-6614
Mailing Address - Fax:856-784-1322
Practice Address - Street 1:1401 LAUREL OAK RD
Practice Address - Street 2:EASTERN HIGH SCHOOL
Practice Address - City:VOORHEES
Practice Address - State:NJ
Practice Address - Zip Code:08043-4304
Practice Address - Country:US
Practice Address - Phone:856-784-4441
Practice Address - Fax:856-784-1322
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MT000552002255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer