Provider Demographics
NPI:1841498961
Name:JOHANNES, CHRISTOPHER MICHAEL (PTA, ATC/L)
Entity type:Individual
Prefix:MR
First Name:CHRISTOPHER
Middle Name:MICHAEL
Last Name:JOHANNES
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Gender:M
Credentials:PTA, ATC/L
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Mailing Address - Street 1:2 POMPERAUG OFFICE PARK
Mailing Address - Street 2:SUITE 303
Mailing Address - City:SOUTHBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06488-2288
Mailing Address - Country:US
Mailing Address - Phone:203-264-1735
Mailing Address - Fax:203-264-9251
Practice Address - Street 1:2 POMPERAUG OFFICE PARK
Practice Address - Street 2:SUITE 303
Practice Address - City:SOUTHBURY
Practice Address - State:CT
Practice Address - Zip Code:06488-2288
Practice Address - Country:US
Practice Address - Phone:203-264-1735
Practice Address - Fax:203-264-9251
Is Sole Proprietor?:No
Enumeration Date:2007-07-10
Last Update Date:2015-07-15
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CT0002932255A2300X
CT1590225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer