Provider Demographics
NPI:1942454053
Name:GEONANGA, CHRISTIAN SALVADOR GONEZ (PT)
Entity Type:Individual
Prefix:
First Name:CHRISTIAN SALVADOR
Middle Name:GONEZ
Last Name:GEONANGA
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 1:1288 S GOVERNORS AVE
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:DE
Mailing Address - Zip Code:19904-4802
Mailing Address - Country:US
Mailing Address - Phone:302-677-0100
Mailing Address - Fax:302-677-0267
Practice Address - Street 1:1812 MARSH RD
Practice Address - Street 2:STORE 505
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19810-4581
Practice Address - Country:US
Practice Address - Phone:302-793-0432
Practice Address - Fax:302-793-0400
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-17
Last Update Date:2009-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEJ1-0002363225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
3688906000OtherIBC AMERIHEALTH
3688906000OtherIBC AMERIHEALTH