Provider Demographics
NPI:1649487133
Name:CLOCK, CHRISTOPHER R (PT)
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:R
Last Name:CLOCK
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 1:10 LIBERTY SQ
Mailing Address - Street 2:BSMT 1
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02109-5814
Mailing Address - Country:US
Mailing Address - Phone:617-536-1161
Mailing Address - Fax:857-239-9711
Practice Address - Street 1:1550 EASTLAKE AVE E
Practice Address - Street 2:SUITE 100
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98102-3728
Practice Address - Country:US
Practice Address - Phone:206-322-2842
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-16
Last Update Date:2020-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00007291225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA5863485OtherAETNA
WA5863485OtherAETNA