Provider Demographics
NPI:1699050997
Name:MERCILL, CHRISTIAN MEYER (PT)
Entity type:Individual
Prefix:
First Name:CHRISTIAN
Middle Name:MEYER
Last Name:MERCILL
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 1:1920 BARNEY RD
Mailing Address - Street 2:
Mailing Address - City:ANDERSON
Mailing Address - State:CA
Mailing Address - Zip Code:96007-4337
Mailing Address - Country:US
Mailing Address - Phone:530-365-2142
Mailing Address - Fax:530-365-5655
Practice Address - Street 1:1920 BARNEY RD
Practice Address - Street 2:
Practice Address - City:ANDERSON
Practice Address - State:CA
Practice Address - Zip Code:96007-4337
Practice Address - Country:US
Practice Address - Phone:530-365-2142
Practice Address - Fax:530-365-5655
Is Sole Proprietor?:No
Enumeration Date:2011-10-18
Last Update Date:2011-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA38233225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPT38233OtherCA PT LICENSE