Basic Information
| Provider Information | |||||||||
| NPI: | 1851605786 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WAHL | ||||||||
| FirstName: | CHRISTOPHER | ||||||||
| MiddleName: | WESLEY | ||||||||
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| Credential: | P.T. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9210 ARBORETUM PKWY | ||||||||
| Address2: | SUITE 260 | ||||||||
| City: | RICHMOND | ||||||||
| State: | VA | ||||||||
| PostalCode: | 232363472 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8049154602 | ||||||||
| FaxNumber: | 8043278496 | ||||||||
| Practice Location | |||||||||
| Address1: | 5899 BREMO RD | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | RICHMOND | ||||||||
| State: | VA | ||||||||
| PostalCode: | 232261935 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8042852645 | ||||||||
| FaxNumber: | 8042872786 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/03/2010 | ||||||||
| LastUpdateDate: | 09/30/2010 | ||||||||
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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 | 2305206592 | VA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | 1851605786 | 05 | VA | MEDICAID |