Provider Demographics
NPI:1174616189
Name:DELK, JONATHAN E (MSPT)
Entity type:Individual
Prefix:MR
First Name:JONATHAN
Middle Name:E
Last Name:DELK
Suffix:
Gender:M
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3125 INDEPENDENCE DR
Mailing Address - Street 2:300B
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35209
Mailing Address - Country:US
Mailing Address - Phone:205-879-7501
Mailing Address - Fax:205-879-0675
Practice Address - Street 1:3125 INDEPENDENCE DR
Practice Address - Street 2:300B
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35209
Practice Address - Country:US
Practice Address - Phone:205-879-7501
Practice Address - Fax:205-879-0675
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2010-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPTH3514225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51502359OtherBLUE CROSS
AL6400002OtherUNITED HEALTHCARE
AL51104595OtherBLUE CROSS BLUE SH TRUSSVILLE LOCATION
AL51502359OtherBLUE CROSS
P90877Medicare UPIN