Provider Demographics
NPI:1457485278
Name:ARCHAMBEAULT, CHRISTOPHER MICHAEL (ATC, LAT)
Entity Type:Individual
Prefix:MR
First Name:CHRISTOPHER
Middle Name:MICHAEL
Last Name:ARCHAMBEAULT
Suffix:
Gender:M
Credentials:ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:515 AUTUMN RIDGE DR.
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:GA
Mailing Address - Zip Code:30115
Mailing Address - Country:US
Mailing Address - Phone:678-372-1623
Mailing Address - Fax:
Practice Address - Street 1:590 COBB AVE
Practice Address - Street 2:
Practice Address - City:KENNESAW
Practice Address - State:GA
Practice Address - Zip Code:30144
Practice Address - Country:US
Practice Address - Phone:470-578-2104
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-15
Last Update Date:2022-02-10
Deactivation Date:2007-07-17
Deactivation Code:
Reactivation Date:2018-03-15
Provider Licenses
StateLicense IDTaxonomies
NC12532255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer