Provider Demographics
NPI:1851605786
Name:WAHL, CHRISTOPHER WESLEY (PT)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:WESLEY
Last Name:WAHL
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:9210 ARBORETUM PKWY
Mailing Address - Street 2:SUITE 260
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23236-3472
Mailing Address - Country:US
Mailing Address - Phone:804-915-4602
Mailing Address - Fax:804-327-8496
Practice Address - Street 1:5899 BREMO RD
Practice Address - Street 2:SUITE 100
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23226-1935
Practice Address - Country:US
Practice Address - Phone:804-285-2645
Practice Address - Fax:804-287-2786
Is Sole Proprietor?:No
Enumeration Date:2010-08-03
Last Update Date:2010-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305206592225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1851605786Medicaid
VA1851605786Medicaid
VA0472640004Medicare NSC