Provider Demographics
NPI:1558830885
Name:URIBE AVALOS, CHRYSTHIAN IVAN
Entity Type:Individual
Prefix:
First Name:CHRYSTHIAN
Middle Name:IVAN
Last Name:URIBE AVALOS
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 1:1200 CORPORATE DR STE 400
Mailing Address - Street 2:
Mailing Address - City:HOOVER
Mailing Address - State:AL
Mailing Address - Zip Code:35242-5424
Mailing Address - Country:US
Mailing Address - Phone:423-238-7217
Mailing Address - Fax:
Practice Address - Street 1:6880 US HIGHWAY 90 STE 10
Practice Address - Street 2:
Practice Address - City:DAPHNE
Practice Address - State:AL
Practice Address - Zip Code:36526-9522
Practice Address - Country:US
Practice Address - Phone:251-210-2901
Practice Address - Fax:251-210-2902
Is Sole Proprietor?:No
Enumeration Date:2018-11-15
Last Update Date:2024-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPTH9207225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist