Provider Demographics
NPI:1053763482
Name:NWANEGWO, CHRISTOPHER (ATC, SCAT)
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:
Last Name:NWANEGWO
Suffix:
Gender:M
Credentials:ATC, SCAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 LYNN CT
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:SC
Mailing Address - Zip Code:29526-8827
Mailing Address - Country:US
Mailing Address - Phone:843-333-4628
Mailing Address - Fax:
Practice Address - Street 1:102 LYNN CT
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:SC
Practice Address - Zip Code:29526-8827
Practice Address - Country:US
Practice Address - Phone:843-333-4628
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-11
Last Update Date:2016-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC19232255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer