Basic Information
| Provider Information | |||||||||
| NPI: | 1538169529 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | AMUNDSON | ||||||||
| FirstName: | CHRIS | ||||||||
| MiddleName: | L. | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | DPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 615 SIERRA ROSE DRIVE | ||||||||
| Address2: | 2A | ||||||||
| City: | RENO | ||||||||
| State: | NV | ||||||||
| PostalCode: | 89511 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7758289724 | ||||||||
| FaxNumber: | 7758289728 | ||||||||
| Practice Location | |||||||||
| Address1: | 615 SIERRA ROSE DRIVE | ||||||||
| Address2: | 2A | ||||||||
| City: | RENO | ||||||||
| State: | NV | ||||||||
| PostalCode: | 89511 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7758289724 | ||||||||
| FaxNumber: | 7758289728 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/31/2005 | ||||||||
| LastUpdateDate: | 08/01/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 4779 | OR | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | 022695 | 05 | OR | MEDICAID | 067873000 | 01 | OR | BLUE CROSS OF OREGON | OTHER |