Provider Demographics
NPI:1740536473
Name:HORNBUCKLE, CHRISTOPHER D
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:D
Last Name:HORNBUCKLE
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 1:1908 FLINT RD SE
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:AL
Mailing Address - Zip Code:35601-6031
Mailing Address - Country:US
Mailing Address - Phone:256-340-9708
Mailing Address - Fax:256-340-9624
Practice Address - Street 1:2506 DANVILLE RD SW
Practice Address - Street 2:SUITE 200
Practice Address - City:DECATUR
Practice Address - State:AL
Practice Address - Zip Code:35603-4232
Practice Address - Country:US
Practice Address - Phone:256-350-6331
Practice Address - Fax:256-350-1990
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-31
Last Update Date:2012-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPTH6545225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL529917620Medicaid
AL1003819608OtherGROUP NPI
ALK531Medicare UPIN