Provider Demographics
NPI:1073980736
Name:JACKSON, CHRISTOPHER G (PT, DPT)
Entity Type:Individual
Prefix:MR
First Name:CHRISTOPHER
Middle Name:G
Last Name:JACKSON
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3143 PELHAM PARKWAY
Mailing Address - Street 2:SUITE 400
Mailing Address - City:PELHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35124
Mailing Address - Country:US
Mailing Address - Phone:205-664-3197
Mailing Address - Fax:205-621-5686
Practice Address - Street 1:3143 PELHAM PKWY STE 400
Practice Address - Street 2:
Practice Address - City:PELHAM
Practice Address - State:AL
Practice Address - Zip Code:35124-6301
Practice Address - Country:US
Practice Address - Phone:205-664-3197
Practice Address - Fax:205-621-5686
Is Sole Proprietor?:No
Enumeration Date:2015-08-28
Last Update Date:2017-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPTH7700225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist