Provider Demographics
NPI:1154534519
Name:CHRIST, DOUGLAS CRAIG (DPT)
Entity type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:CRAIG
Last Name:CHRIST
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2321 COURT ST
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96001-2527
Mailing Address - Country:US
Mailing Address - Phone:530-242-8480
Mailing Address - Fax:530-242-8485
Practice Address - Street 1:2321 COURT ST
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96001-2527
Practice Address - Country:US
Practice Address - Phone:530-242-8480
Practice Address - Fax:530-242-8485
Is Sole Proprietor?:No
Enumeration Date:2007-05-08
Last Update Date:2012-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT 27512225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGPT001550Medicaid
CAGPT001550Medicaid