Provider Demographics
NPI:1144282062
Name:CLIFFORD, CHRISTOPHER M (ATC/L)
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:M
Last Name:CLIFFORD
Suffix:
Gender:M
Credentials:ATC/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 WINSTON DR
Mailing Address - Street 2:APT A1
Mailing Address - City:COOKEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38506-4607
Mailing Address - Country:US
Mailing Address - Phone:574-229-7934
Mailing Address - Fax:
Practice Address - Street 1:1160 N. PEACHTREE RM 114
Practice Address - Street 2:
Practice Address - City:COOKEVILLE
Practice Address - State:TN
Practice Address - Zip Code:38505-0001
Practice Address - Country:US
Practice Address - Phone:931-372-3934
Practice Address - Fax:931-372-3964
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN9652255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer