Provider Demographics
NPI:1912232851
Name:NEEL, CHRISTOPHER VANCOURT (PTA)
Entity Type:Individual
Prefix:MR
First Name:CHRISTOPHER
Middle Name:VANCOURT
Last Name:NEEL
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:979 ORCHID WAY
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92154-1533
Mailing Address - Country:US
Mailing Address - Phone:619-429-1538
Mailing Address - Fax:
Practice Address - Street 1:1625 E MAIN ST
Practice Address - Street 2:SUITE NUMBER 101
Practice Address - City:EL CAJON
Practice Address - State:CA
Practice Address - Zip Code:92021-5211
Practice Address - Country:US
Practice Address - Phone:619-440-9444
Practice Address - Fax:619-440-9445
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-09
Last Update Date:2009-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAT 3157225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant