Provider Demographics
NPI:1851497929
Name:EVERETT, CHRISTOPHER LEE (PTA)
Entity Type:Individual
Prefix:MR
First Name:CHRISTOPHER
Middle Name:LEE
Last Name:EVERETT
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3376 RAMBLEWOOD PL
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34237-3836
Mailing Address - Country:US
Mailing Address - Phone:941-365-5399
Mailing Address - Fax:
Practice Address - Street 1:4964 FRUITVILLE RD
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34232-2261
Practice Address - Country:US
Practice Address - Phone:941-341-9480
Practice Address - Fax:941-341-9490
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL20573225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL20573OtherPTA LISCENSURE