Provider Demographics
NPI:1144601758
Name:BALENTINE, CHRISTOPHER EDWIN JR (DPT)
Entity Type:Individual
Prefix:MR
First Name:CHRISTOPHER
Middle Name:EDWIN
Last Name:BALENTINE
Suffix:JR
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 869
Mailing Address - Street 2:
Mailing Address - City:ROGERVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35652-0869
Mailing Address - Country:US
Mailing Address - Phone:256-247-5000
Mailing Address - Fax:256-247-5005
Practice Address - Street 1:48 MARKET SQUARE
Practice Address - Street 2:
Practice Address - City:ROGERVILLE
Practice Address - State:AL
Practice Address - Zip Code:35652
Practice Address - Country:US
Practice Address - Phone:256-247-5000
Practice Address - Fax:256-247-5005
Is Sole Proprietor?:No
Enumeration Date:2015-06-10
Last Update Date:2022-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPTH7564225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL1689118820OtherGROUP NPI
AL1992871073OtherGROUP NPI
AL1003819608OtherGROUP NPI
AL241462Medicaid
AL529917620Medicaid