Provider Demographics
NPI:1528138500
Name:CHURCH, JON PAUL (MSPT, ATC)
Entity type:Individual
Prefix:MR
First Name:JON
Middle Name:PAUL
Last Name:CHURCH
Suffix:
Gender:M
Credentials:MSPT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:335 NEW HOPE MOUNTAIN RD
Mailing Address - Street 2:
Mailing Address - City:INDIAN SPRINGS
Mailing Address - State:AL
Mailing Address - Zip Code:35124-3719
Mailing Address - Country:US
Mailing Address - Phone:205-824-0610
Mailing Address - Fax:205-824-6263
Practice Address - Street 1:2090 COLUMBIANA RD
Practice Address - Street 2:SUITE 1000
Practice Address - City:VESTAVIA
Practice Address - State:AL
Practice Address - Zip Code:35216-2153
Practice Address - Country:US
Practice Address - Phone:205-824-0610
Practice Address - Fax:205-824-6263
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPTH3279225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51516141OtherBLUE CROSS BLUE SHIELD