Provider Demographics
NPI:1750372116
Name:PROCTOR, CHRISTOPHER S (PT)
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:S
Last Name:PROCTOR
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 529
Mailing Address - Street 2:
Mailing Address - City:ZEPHYR COVE
Mailing Address - State:NV
Mailing Address - Zip Code:89448-0529
Mailing Address - Country:US
Mailing Address - Phone:775-588-8938
Mailing Address - Fax:775-588-8930
Practice Address - Street 1:1139 3RD ST
Practice Address - Street 2:
Practice Address - City:SOUTH LAKE TAHOE
Practice Address - State:CA
Practice Address - Zip Code:96150-3465
Practice Address - Country:US
Practice Address - Phone:530-541-3100
Practice Address - Fax:530-541-3016
Is Sole Proprietor?:No
Enumeration Date:2005-11-03
Last Update Date:2007-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT22738225100000X
NV1203225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAP00211696OtherMEDICARE RAILROAD
NVCC7486OtherBCBS
CAPT0227380OtherMEDI-CAL
CA0PT227382Medicare PIN
S04852Medicare UPIN