Provider Demographics
NPI:1457562829
Name:GROSSMAN, CHRISTOPHER ANTHONY (MPT)
Entity Type:Individual
Prefix:MR
First Name:CHRISTOPHER
Middle Name:ANTHONY
Last Name:GROSSMAN
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 1:1322 MISSION AVE
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:NM
Mailing Address - Zip Code:88220-9647
Mailing Address - Country:US
Mailing Address - Phone:505-887-9788
Mailing Address - Fax:
Practice Address - Street 1:1905 W PIERCE ST
Practice Address - Street 2:
Practice Address - City:CARLSBAD
Practice Address - State:NM
Practice Address - Zip Code:88220-4025
Practice Address - Country:US
Practice Address - Phone:505-885-3161
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM3178225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist