Provider Demographics
NPI:1760628002
Name:DISISTO, CHRISTOPHER MICHAEL SR (PT DPT)
Entity type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:MICHAEL
Last Name:DISISTO
Suffix:SR
Gender:M
Credentials:PT DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:141 E CHURCH ST STE N
Mailing Address - Street 2:
Mailing Address - City:BATESBURG LEESVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29070-7066
Mailing Address - Country:US
Mailing Address - Phone:803-532-3335
Mailing Address - Fax:803-532-3337
Practice Address - Street 1:141 E CHURCH ST STE N
Practice Address - Street 2:
Practice Address - City:BATESBURG LEESVILLE
Practice Address - State:SC
Practice Address - Zip Code:29070-7066
Practice Address - Country:US
Practice Address - Phone:803-532-3335
Practice Address - Fax:803-532-3337
Is Sole Proprietor?:No
Enumeration Date:2008-12-16
Last Update Date:2024-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC109022251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic