Provider Demographics
NPI:1457032336
Name:MCDONALD, CHRISTOPHER SHANE (LAT, ATC, PES)
Entity Type:Individual
Prefix:MR
First Name:CHRISTOPHER
Middle Name:SHANE
Last Name:MCDONALD
Suffix:
Gender:M
Credentials:LAT, ATC, PES
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 N WATER ST APT 523
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36602-4064
Mailing Address - Country:US
Mailing Address - Phone:251-277-1912
Mailing Address - Fax:
Practice Address - Street 1:300 JOSEPH GOTTFRIED DRIVE
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36688-0001
Practice Address - Country:US
Practice Address - Phone:251-277-1912
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-25
Last Update Date:2023-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL13832255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer