Provider Demographics
NPI:1811995244
Name:POWELL, CHRISTOPHER ALLEN (PT)
Entity type:Individual
Prefix:MR
First Name:CHRISTOPHER
Middle Name:ALLEN
Last Name:POWELL
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 1:3702 SHORE AVE
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98203-1229
Mailing Address - Country:US
Mailing Address - Phone:425-348-4181
Mailing Address - Fax:425-348-3012
Practice Address - Street 1:3702 SHORE AVE
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98203-1229
Practice Address - Country:US
Practice Address - Phone:425-348-4181
Practice Address - Fax:425-348-3012
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-11
Last Update Date:2007-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00003429225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAGAB20980Medicare ID - Type UnspecifiedP.T. PROVIDER NUMBER