Provider Demographics
NPI:1740971894
Name:TATE, CHRISTOPHER RYAN (PT, DPT)
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:RYAN
Last Name:TATE
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:209 COTTAGE GREEN LN
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:LA
Mailing Address - Zip Code:70435-5641
Mailing Address - Country:US
Mailing Address - Phone:985-773-3202
Mailing Address - Fax:
Practice Address - Street 1:129 CORPORATE DR
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:LA
Practice Address - Zip Code:70433-1057
Practice Address - Country:US
Practice Address - Phone:985-249-6111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-18
Last Update Date:2023-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA11503225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist