Provider Demographics
NPI:1194810945
Name:BERTANI, CHRISTOPHER JOHN (MSPT,OCS,CSCS)
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:JOHN
Last Name:BERTANI
Suffix:
Gender:M
Credentials:MSPT,OCS,CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5859 HARBOUR VIEW BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SUFFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23435-3015
Mailing Address - Country:US
Mailing Address - Phone:757-686-0205
Mailing Address - Fax:757-686-0206
Practice Address - Street 1:5859 HARBOUR VIEW BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:SUFFOLK
Practice Address - State:VA
Practice Address - Zip Code:23435-3015
Practice Address - Country:US
Practice Address - Phone:757-686-0205
Practice Address - Fax:757-686-0206
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2009-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY23069225100000X
VA2305205942225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY11225349OtherCAQH NUMBER
NYDD3761Medicare ID - Type Unspecified