Provider Demographics
NPI:1902829278
Name:GANT, CHRISTOPHER C (PT)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:C
Last Name:GANT
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1218 3RD AVE
Mailing Address - Street 2:SUITE 104
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98101-3097
Mailing Address - Country:US
Mailing Address - Phone:206-447-2220
Mailing Address - Fax:206-447-2228
Practice Address - Street 1:1218 3RD AVE
Practice Address - Street 2:SUITE 104
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98101-3097
Practice Address - Country:US
Practice Address - Phone:206-447-2220
Practice Address - Fax:206-447-2228
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2013-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00008158225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7102924Medicaid
WA7102924Medicaid