Provider Demographics
NPI:1750446837
Name:DIMATTIA, CHRISTOPHER COREY (DPT)
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:COREY
Last Name:DIMATTIA
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 1:8521 E CYPRESS POINT CT
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70809-2283
Mailing Address - Country:US
Mailing Address - Phone:225-235-6161
Mailing Address - Fax:
Practice Address - Street 1:28977 WALKER SOUTH ROAD
Practice Address - Street 2:SUITE G
Practice Address - City:WALKER
Practice Address - State:LA
Practice Address - Zip Code:70785
Practice Address - Country:US
Practice Address - Phone:225-271-8056
Practice Address - Fax:225-271-8057
Is Sole Proprietor?:No
Enumeration Date:2006-12-27
Last Update Date:2009-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA07076225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA07076OtherSTATE LICENSE #