Provider Demographics
NPI:1649443961
Name:VIDAL, CHRISTOPHER QUIAMBAO (PT)
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:QUIAMBAO
Last Name:VIDAL
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:560 E 3RD ST
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16507-1753
Mailing Address - Country:US
Mailing Address - Phone:814-878-4965
Mailing Address - Fax:814-871-4617
Practice Address - Street 1:560 E 3RD ST
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16507-1753
Practice Address - Country:US
Practice Address - Phone:814-878-4965
Practice Address - Fax:814-871-4617
Is Sole Proprietor?:No
Enumeration Date:2008-04-08
Last Update Date:2008-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT011516L225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist