Provider Demographics
NPI:1194166330
Name:HJELMELAND, MARK DAVID (DPT)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:DAVID
Last Name:HJELMELAND
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:805 SAINT VINCENTS DR
Mailing Address - Street 2:SUITE G100
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35205-1636
Mailing Address - Country:US
Mailing Address - Phone:205-939-1557
Mailing Address - Fax:
Practice Address - Street 1:805 SAINT VINCENTS DR
Practice Address - Street 2:SUITE G100
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35205-1636
Practice Address - Country:US
Practice Address - Phone:205-939-1557
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-16
Last Update Date:2014-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPTH6788225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist