Provider Demographics
NPI:1528052537
Name:FERTAL, CHRISTOPHER ALAN (ATC,EMT,CSCS)
Entity type:Individual
Prefix:MR
First Name:CHRISTOPHER
Middle Name:ALAN
Last Name:FERTAL
Suffix:
Gender:M
Credentials:ATC,EMT,CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:279 CONGRESS AVE
Mailing Address - Street 2:
Mailing Address - City:LANSDOWNE
Mailing Address - State:PA
Mailing Address - Zip Code:19050-1206
Mailing Address - Country:US
Mailing Address - Phone:610-960-6822
Mailing Address - Fax:
Practice Address - Street 1:1101 CITY AVE
Practice Address - Street 2:
Practice Address - City:WYNNEWOOD
Practice Address - State:PA
Practice Address - Zip Code:19096-3418
Practice Address - Country:US
Practice Address - Phone:610-645-5089
Practice Address - Fax:610-658-5616
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PART0032582255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer