Provider Demographics
NPI:1316669641
Name:PRATT, CHRISTIAN KILMAN
Entity type:Individual
Prefix:
First Name:CHRISTIAN
Middle Name:KILMAN
Last Name:PRATT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2307 HAILE STREET EXT
Mailing Address - Street 2:
Mailing Address - City:CAMDEN
Mailing Address - State:SC
Mailing Address - Zip Code:29020-3160
Mailing Address - Country:US
Mailing Address - Phone:803-549-7616
Mailing Address - Fax:
Practice Address - Street 1:2307 HAILE STREET EXT
Practice Address - Street 2:
Practice Address - City:CAMDEN
Practice Address - State:SC
Practice Address - Zip Code:29020-3160
Practice Address - Country:US
Practice Address - Phone:803-549-7616
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-13
Last Update Date:2022-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC12207819862255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer