Individual
CHRISTOPHER LICEA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DPT
Contact information
Practice address
160 RIVER BEND DR STE 104, GRANITE FALLS, NC 28630-9389
(828) 212-5098
(828) 313-0376
Mailing address
3280 WOODBRIAR LN, TALLAHASSEE, FL 32303-7563
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
P22816
NC
225100000X
Physical Therapist
PT39209
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
P22816
PT LICENSE
NC
Enumeration date
08/15/2022
Last updated
05/14/2024
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