Provider Demographics
NPI:1417355405
Name:DAVIS, CHRISTOPHER EVERETT (DPT)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:EVERETT
Last Name:DAVIS
Suffix:
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 1:8823 PRODUCTION LN
Mailing Address - Street 2:
Mailing Address - City:OOLTEWAH
Mailing Address - State:TN
Mailing Address - Zip Code:37363-6511
Mailing Address - Country:US
Mailing Address - Phone:423-238-7217
Mailing Address - Fax:423-238-3473
Practice Address - Street 1:4500 MONTEVALLO RD
Practice Address - Street 2:STE B108
Practice Address - City:IRONDALE
Practice Address - State:AL
Practice Address - Zip Code:35210-3129
Practice Address - Country:US
Practice Address - Phone:205-957-0870
Practice Address - Fax:205-957-0872
Is Sole Proprietor?:No
Enumeration Date:2014-12-08
Last Update Date:2016-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPTH7481225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL511-57979OtherBCBS-ATHENS
AL511-57981OtherBCBS-HOOVER
009838OtherOPTUM
AL102I652168OtherMEDICARE PTAN
AL511-57983OtherBCBS-WEST MADISON
AL511-57980OtherBCBS-CHELSEA
AL511-57984OtherBCBS-ALTADENA
AL511-57982OtherBCBS-MOODY