Provider Demographics
NPI:1427294016
Name:FEARON, CHRISTOPHER WAYNE (PT)
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:WAYNE
Last Name:FEARON
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:221 N HOGAN ST
Mailing Address - Street 2:SUITE 259
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32202-4201
Mailing Address - Country:US
Mailing Address - Phone:904-357-0060
Mailing Address - Fax:
Practice Address - Street 1:221 N HOGAN ST
Practice Address - Street 2:SUITE 259
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32202-4201
Practice Address - Country:US
Practice Address - Phone:904-357-0060
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-01-02
Last Update Date:2009-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT21735225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist