1871722090 NPI number — CHRISTOPHER MICHAEL CORTESE JR. PT, DPT

Table of content: CHRISTOPHER MICHAEL CORTESE JR. PT, DPT (NPI 1871722090)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1871722090 NPI number — CHRISTOPHER MICHAEL CORTESE JR. PT, DPT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CORTESE
Provider First Name:
CHRISTOPHER
Provider Middle Name:
MICHAEL
Provider Name Prefix Text:
Provider Name Suffix Text:
JR.
Provider Credential Text:
PT, DPT
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:
1871722090
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/23/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
400S MAIN ST D
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAINT MARTINVILLE
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70582-4544
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
337-394-3757
Provider Business Mailing Address Fax Number:
337-394-3758

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2626 NORTH DRIVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ABBEVILLE
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70510
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
337-893-4500
Provider Business Practice Location Address Fax Number:
337-893-2979
Provider Enumeration Date:
07/09/2009

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:  07615 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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