Provider Demographics
NPI:1912730797
Name:CANTU, CHRISTOPHER LOGAN (DPT)
Entity type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:LOGAN
Last Name:CANTU
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:46 OLD COURTHOUSE RD
Mailing Address - Street 2:
Mailing Address - City:NATCHEZ
Mailing Address - State:MS
Mailing Address - Zip Code:39120-8436
Mailing Address - Country:US
Mailing Address - Phone:601-520-1826
Mailing Address - Fax:855-952-2013
Practice Address - Street 1:500 MAIN ST STE R
Practice Address - Street 2:
Practice Address - City:NATCHEZ
Practice Address - State:MS
Practice Address - Zip Code:39120-3364
Practice Address - Country:US
Practice Address - Phone:601-520-1826
Practice Address - Fax:855-952-2013
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-26
Last Update Date:2024-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSCP033431A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty