Provider Demographics
NPI:1942467949
Name:CHRISTENSEN, EDWARD PETER IV (DPT, CSCS)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:PETER
Last Name:CHRISTENSEN
Suffix:IV
Gender:M
Credentials:DPT, CSCS
Other - Prefix:DR
Other - First Name:CHRIS
Other - Middle Name:
Other - Last Name:CHRISTENSEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DPT,CSCS
Mailing Address - Street 1:9000 SOQUEL AVE STE 103
Mailing Address - Street 2:
Mailing Address - City:SANTA CRUZ
Mailing Address - State:CA
Mailing Address - Zip Code:95062-2097
Mailing Address - Country:US
Mailing Address - Phone:831-464-8200
Mailing Address - Fax:
Practice Address - Street 1:9000 SOQUEL AVE STE 103
Practice Address - Street 2:
Practice Address - City:SANTA CRUZ
Practice Address - State:CA
Practice Address - Zip Code:95062-2097
Practice Address - Country:US
Practice Address - Phone:831-464-8200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-19
Last Update Date:2008-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT 26498225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist