Provider Demographics
NPI:1235960816
Name:ELLIOTT-PERSON, CHRISTOPHER LESHAWN
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:LESHAWN
Last Name:ELLIOTT-PERSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2100 NE BROADWAY ST STE 125
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97232-1500
Mailing Address - Country:US
Mailing Address - Phone:503-477-8222
Mailing Address - Fax:971-373-8648
Practice Address - Street 1:2100 NE BROADWAY ST STE 125
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97232-1500
Practice Address - Country:US
Practice Address - Phone:503-477-8222
Practice Address - Fax:971-373-8648
Is Sole Proprietor?:No
Enumeration Date:2024-08-13
Last Update Date:2024-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR27671225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist