Provider Demographics
NPI:1861742280
Name:FANNING, CHRISTOPHER ROBERT (PT, RD)
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:ROBERT
Last Name:FANNING
Suffix:
Gender:M
Credentials:PT, RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 DENIM PL
Mailing Address - Street 2:
Mailing Address - City:N WHITE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:10603-1717
Mailing Address - Country:US
Mailing Address - Phone:914-439-1392
Mailing Address - Fax:
Practice Address - Street 1:24 DENIM PL
Practice Address - Street 2:
Practice Address - City:N WHITE PLAINS
Practice Address - State:NY
Practice Address - Zip Code:10603-1717
Practice Address - Country:US
Practice Address - Phone:914-439-1392
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-12
Last Update Date:2012-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY019532-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist