Provider Demographics
NPI:1457703969
Name:WOMBLE, CHRISTOPHER CHAD (DPT)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:CHAD
Last Name:WOMBLE
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1900 LONG PRAIRIE RD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:FLOWER MOUND
Mailing Address - State:TX
Mailing Address - Zip Code:75022
Mailing Address - Country:US
Mailing Address - Phone:972-724-2400
Mailing Address - Fax:972-724-2495
Practice Address - Street 1:4364 HERITAGE TRACE PKWY
Practice Address - Street 2:SUITE 108
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76244-9106
Practice Address - Country:US
Practice Address - Phone:817-379-1400
Practice Address - Fax:817-379-1404
Is Sole Proprietor?:No
Enumeration Date:2016-07-08
Last Update Date:2016-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1280617225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist