Basic Information
| Provider Information | |||||||||
| NPI: | 1962551051 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ROY | ||||||||
| FirstName: | CHRISTOPHER | ||||||||
| MiddleName: | TODD | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | M.ED.,ATC, LAT, CSCS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1017 N VERDA ST | ||||||||
| Address2: | |||||||||
| City: | WICHITA | ||||||||
| State: | KS | ||||||||
| PostalCode: | 672034373 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3169433757 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 12112 W KELLOGG ST | ||||||||
| Address2: | |||||||||
| City: | WICHITA | ||||||||
| State: | KS | ||||||||
| PostalCode: | 672351100 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3164401100 | ||||||||
| FaxNumber: | 3164401089 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/09/2007 | ||||||||
| LastUpdateDate: | 05/14/2014 | ||||||||
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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 | 2255A2300X | 24-00388 | KS | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Specialist/Technologist | Athletic Trainer | 2255A2300X | 060002519 | KS | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Specialist/Technologist | Athletic Trainer |
No ID Information.