Provider Demographics
NPI:1053604330
Name:HUMPHREYS, CHRISTOPHER RYAN (PT, DPT)
Entity type:Individual
Prefix:MR
First Name:CHRISTOPHER
Middle Name:RYAN
Last Name:HUMPHREYS
Suffix:
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 1:8823 PRODUCTION LN
Mailing Address - Street 2:
Mailing Address - City:OOLTEWAH
Mailing Address - State:TN
Mailing Address - Zip Code:37363-6511
Mailing Address - Country:US
Mailing Address - Phone:423-238-8923
Mailing Address - Fax:423-954-7399
Practice Address - Street 1:275 JACKSON MEADOWS DR
Practice Address - Street 2:SUITE 101
Practice Address - City:HERMITAGE
Practice Address - State:TN
Practice Address - Zip Code:37076-1453
Practice Address - Country:US
Practice Address - Phone:615-885-7848
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-19
Last Update Date:2017-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN8689225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist