Provider Demographics
NPI:1245271550
Name:PRIBISH, CHRISTOPHER S
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:S
Last Name:PRIBISH
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 1:4 COMMONS AVE
Mailing Address - Street 2:SUITE 4D
Mailing Address - City:WINDHAM
Mailing Address - State:ME
Mailing Address - Zip Code:04062-5554
Mailing Address - Country:US
Mailing Address - Phone:207-892-7642
Mailing Address - Fax:207-892-8440
Practice Address - Street 1:4 COMMONS AVE
Practice Address - Street 2:SUITE 4D
Practice Address - City:WINDHAM
Practice Address - State:ME
Practice Address - Zip Code:04062-5554
Practice Address - Country:US
Practice Address - Phone:207-892-7642
Practice Address - Fax:207-892-8440
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEAT2412255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer