Provider Demographics
NPI:1174550560
Name:PURVIS, CHRIS (PT, ATC)
Entity type:Individual
Prefix:
First Name:CHRIS
Middle Name:
Last Name:PURVIS
Suffix:
Gender:M
Credentials:PT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11320 INDUSTRIPLEX BOULEVARD
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70809
Mailing Address - Country:US
Mailing Address - Phone:225-295-8183
Mailing Address - Fax:225-752-2937
Practice Address - Street 1:11320 INDUSTRIPLEX BOULEVARD
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70809
Practice Address - Country:US
Practice Address - Phone:225-295-8183
Practice Address - Fax:225-752-2937
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2020-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
2251X0800X
LA01016225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
5X069C610Medicare PIN