Provider Demographics
NPI:1952162851
Name:GLEASON, CHRISTOPHER (ATC)
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:
Last Name:GLEASON
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:602 LOUISIANA ST
Mailing Address - Street 2:
Mailing Address - City:PURVIS
Mailing Address - State:MS
Mailing Address - Zip Code:39475-4067
Mailing Address - Country:US
Mailing Address - Phone:601-520-0830
Mailing Address - Fax:
Practice Address - Street 1:220 SCHOOL ST
Practice Address - Street 2:
Practice Address - City:PURVIS
Practice Address - State:MS
Practice Address - Zip Code:39475-9002
Practice Address - Country:US
Practice Address - Phone:601-794-6221
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-17
Last Update Date:2024-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSAT-04312255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer