Provider Demographics
NPI:1396115481
Name:HAVEL, CHRISTOPHER THOMAS (MPT)
Entity type:Individual
Prefix:MR
First Name:CHRISTOPHER
Middle Name:THOMAS
Last Name:HAVEL
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:156 MOONLIGHT DR
Mailing Address - Street 2:
Mailing Address - City:FRIDAY HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98250-8294
Mailing Address - Country:US
Mailing Address - Phone:360-622-9141
Mailing Address - Fax:
Practice Address - Street 1:156 MOONLIGHT DR
Practice Address - Street 2:
Practice Address - City:FRIDAY HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98250-8294
Practice Address - Country:US
Practice Address - Phone:360-622-9141
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-01
Last Update Date:2018-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT 00006824225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist