Provider Demographics
NPI:1518764034
Name:KOLLER, CHRISTOPHER (PTA)
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:
Last Name:KOLLER
Suffix:
Gender:
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44 SOUTH ST
Mailing Address - Street 2:
Mailing Address - City:ROCKPORT
Mailing Address - State:MA
Mailing Address - Zip Code:01966-1800
Mailing Address - Country:US
Mailing Address - Phone:978-546-9866
Mailing Address - Fax:
Practice Address - Street 1:44 SOUTH ST
Practice Address - Street 2:
Practice Address - City:ROCKPORT
Practice Address - State:MA
Practice Address - Zip Code:01966-1800
Practice Address - Country:US
Practice Address - Phone:978-546-9866
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-03
Last Update Date:2025-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA8570225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant