1336549229 NPI number — CHRISTOPHER R LAPRAY DPT, ATC

Table of content: CHRISTOPHER R LAPRAY DPT, ATC (NPI 1336549229)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336549229 NPI number — CHRISTOPHER R LAPRAY DPT, ATC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LAPRAY
Provider First Name:
CHRISTOPHER
Provider Middle Name:
R
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DPT, ATC
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1336549229
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/07/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1280 CHANDLER DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SPOONER
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
54801-2202
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
715-939-1745
Provider Business Mailing Address Fax Number:
715-939-1557

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
12226 S 1000 E STE 1
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DRAPER
Provider Business Practice Location Address State Name:
UT
Provider Business Practice Location Address Postal Code:
84020-3205
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
801-523-3415
Provider Business Practice Location Address Fax Number:
801-523-1843
Provider Enumeration Date:
08/27/2014

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  12948-24 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 225100000X , with the licence number: 8887515-2401 , registered in the state of UT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)