Provider Demographics
NPI:1578870895
Name:PHILLIPS, CHRISTAN BISHOP (PT, DPT)
Entity Type:Individual
Prefix:DR
First Name:CHRISTAN
Middle Name:BISHOP
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:CHRISTAN
Other - Middle Name:JADE
Other - Last Name:BISHOP
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:1890 OLD HIGHWAY 5 S
Mailing Address - Street 2:
Mailing Address - City:THOMASVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:36784-5854
Mailing Address - Country:US
Mailing Address - Phone:334-456-9578
Mailing Address - Fax:334-456-9578
Practice Address - Street 1:126 ALABAMA AVE W
Practice Address - Street 2:
Practice Address - City:THOMASVILLE
Practice Address - State:AL
Practice Address - Zip Code:36784-3100
Practice Address - Country:US
Practice Address - Phone:334-456-9578
Practice Address - Fax:334-456-9578
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-08
Last Update Date:2023-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPTH5937225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL1003819608OtherGROUP NPI
AL529917620Medicaid
AL1003819608OtherGROUP NPI