Healthcare Provider Details

I. General information

NPI: 1740536473
Provider Name (Legal Business Name): CHRISTOPHER D HORNBUCKLE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/31/2012
Last Update Date: 07/31/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2506 DANVILLE RD SW SUITE 200
DECATUR AL
35603-4232
US

IV. Provider business mailing address

1908 FLINT RD SE
DECATUR AL
35601-6031
US

V. Phone/Fax

Practice location:
  • Phone: 256-350-6331
  • Fax: 256-350-1990
Mailing address:
  • Phone: 256-340-9708
  • Fax: 256-340-9624

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPTH6545
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: