Provider Demographics
NPI:1770073066
Name:CHISM, CHRISTOPHER WOODROW (DPT, LAT, ATC)
Entity type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:WOODROW
Last Name:CHISM
Suffix:
Gender:M
Credentials:DPT, LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PSC 836 BOX 294
Mailing Address - Street 2:
Mailing Address - City:FPO
Mailing Address - State:AE
Mailing Address - Zip Code:09636-0005
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:NMRTC SIGONELLA
Practice Address - Street 2:95121 VILLAGGIO DEGLI ULIVI
Practice Address - City:SIGONELLA
Practice Address - State:CATANIA
Practice Address - Zip Code:95121
Practice Address - Country:IT
Practice Address - Phone:573-489-4461
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-14
Last Update Date:2024-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI17332255A2300X
WI14151225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer