Provider Demographics
NPI:1336548478
Name:HALLBERG, CHRISTOPHER (MAT, LAT, ATC)
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:
Last Name:HALLBERG
Suffix:
Gender:M
Credentials:MAT, LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:188 SAGE LN
Mailing Address - Street 2:
Mailing Address - City:MADISON HEIGHTS
Mailing Address - State:VA
Mailing Address - Zip Code:24572-6090
Mailing Address - Country:US
Mailing Address - Phone:434-944-4804
Mailing Address - Fax:
Practice Address - Street 1:188 SAGE LN
Practice Address - Street 2:
Practice Address - City:MADISON HEIGHTS
Practice Address - State:VA
Practice Address - Zip Code:24572-6090
Practice Address - Country:US
Practice Address - Phone:434-944-4804
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-14
Last Update Date:2014-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01260021402255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer