Provider Demographics
NPI:1255910600
Name:WESDOCK, CHRISTOPHER GREGORY (PT, DPT)
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:GREGORY
Last Name:WESDOCK
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 1:9359 CASSADINE CT
Mailing Address - Street 2:
Mailing Address - City:LELAND
Mailing Address - State:NC
Mailing Address - Zip Code:28451-1860
Mailing Address - Country:US
Mailing Address - Phone:804-517-6216
Mailing Address - Fax:
Practice Address - Street 1:20 MEDICAL CAMPUS DR NW STE 204
Practice Address - Street 2:
Practice Address - City:SUPPLY
Practice Address - State:NC
Practice Address - Zip Code:28462-4094
Practice Address - Country:US
Practice Address - Phone:910-755-5861
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-05
Last Update Date:2022-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305214298225100000X
NCP20545225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist