Provider Demographics
NPI:1619278892
Name:WILD, CHRISTOPHER D (PT, DPT)
Entity type:Individual
Prefix:MR
First Name:CHRISTOPHER
Middle Name:D
Last Name:WILD
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Gender:M
Credentials:PT, DPT
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Mailing Address - Street 1:3001 EDWARDS MILL RD
Mailing Address - Street 2:200
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27612-5243
Mailing Address - Country:US
Mailing Address - Phone:919-781-4060
Mailing Address - Fax:919-781-5246
Practice Address - Street 1:2400 SUMNER BLVD
Practice Address - Street 2:SUITE 120
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27616-6675
Practice Address - Country:US
Practice Address - Phone:919-876-1100
Practice Address - Fax:919-876-1186
Is Sole Proprietor?:No
Enumeration Date:2010-11-04
Last Update Date:2015-09-14
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NCP13698225100000X
NY033230-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist