Provider Demographics
NPI:1043660145
Name:AHEARN, CHRISTOPHER M (DPT)
Entity type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:M
Last Name:AHEARN
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1568 HOLT RD
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:NY
Mailing Address - Zip Code:14839-9798
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1568 HOLT RD
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:NY
Practice Address - Zip Code:14839-9798
Practice Address - Country:US
Practice Address - Phone:607-661-0903
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-20
Last Update Date:2016-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY038035-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist