Provider Demographics
NPI:1124185145
Name:SELDOMRIDGE, CHRISTOPHER ALLYN (LAT, ATC PES, CEAS)
Entity type:Individual
Prefix:MR
First Name:CHRISTOPHER
Middle Name:ALLYN
Last Name:SELDOMRIDGE
Suffix:
Gender:M
Credentials:LAT, ATC PES, CEAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 E EVERGREEN RD
Mailing Address - Street 2:105 E. EVERGREEN RD
Mailing Address - City:LEBANON
Mailing Address - State:PA
Mailing Address - Zip Code:17042-7505
Mailing Address - Country:US
Mailing Address - Phone:717-272-2033
Mailing Address - Fax:717-389-1880
Practice Address - Street 1:115 E EVERGREEN RD
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:PA
Practice Address - Zip Code:17042-7505
Practice Address - Country:US
Practice Address - Phone:717-272-2033
Practice Address - Fax:717-389-1880
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-02
Last Update Date:2014-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH02522255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer