Provider Demographics
NPI:1770588238
Name:GREETHAM, CHRISTOPHER (PT)
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:
Last Name:GREETHAM
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 1:12544 DILLINGHAM SQ
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22192-5259
Mailing Address - Country:US
Mailing Address - Phone:703-730-6969
Mailing Address - Fax:703-730-1169
Practice Address - Street 1:12544 DILLINGHAM SQ
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22192-5259
Practice Address - Country:US
Practice Address - Phone:703-730-6969
Practice Address - Fax:703-730-1169
Is Sole Proprietor?:No
Enumeration Date:2005-06-20
Last Update Date:2022-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305004216225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA265662OtherANTHEM PROVIDER NUMBER
VAS427-0002OtherCAREFIRST BCBS PROVIDER #