Provider Demographics
NPI:1043708852
Name:BABB, CHRISTOPHER J (LMT)
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:J
Last Name:BABB
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 SW SAINT CLAIR AVE APT 405
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97205-1327
Mailing Address - Country:US
Mailing Address - Phone:617-953-7540
Mailing Address - Fax:
Practice Address - Street 1:806 SW BROADWAY STE 350
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97205-3336
Practice Address - Country:US
Practice Address - Phone:503-224-5911
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-26
Last Update Date:2018-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR22054225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist