Provider Demographics
NPI:1659337327
Name:DUTTON, CHRISTINA KILLCREAS (MSPT)
Entity Type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:KILLCREAS
Last Name:DUTTON
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:CHRISTY
Other - Middle Name:KILLCREAS
Other - Last Name:DUTTON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MSPT
Mailing Address - Street 1:2147 RIVERCHASE OFFICE RD
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AZ
Mailing Address - Zip Code:35244
Mailing Address - Country:US
Mailing Address - Phone:205-403-8902
Mailing Address - Fax:205-982-7882
Practice Address - Street 1:1682 MONTGOMERY HWY
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AZ
Practice Address - Zip Code:35216
Practice Address - Country:US
Practice Address - Phone:205-421-0000
Practice Address - Fax:205-421-2016
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPTH2391225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALPPTOtherBLUE CROSS BLUE SHIELD
AL7689071OtherAETNA
AL7689071OtherAETNA