Provider Demographics
NPI:1487054235
Name:IRELAND, CHRISTOPHER B (DPT)
Entity type:Individual
Prefix:MR
First Name:CHRISTOPHER
Middle Name:B
Last Name:IRELAND
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 1:80 TECHNACENTER DR
Mailing Address - Street 2:SUITE 300
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36117-6028
Mailing Address - Country:US
Mailing Address - Phone:334-625-5795
Mailing Address - Fax:334-396-4905
Practice Address - Street 1:7061 HALCYON SUMMIT DR
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36117-6927
Practice Address - Country:US
Practice Address - Phone:334-396-2110
Practice Address - Fax:334-396-2115
Is Sole Proprietor?:No
Enumeration Date:2014-08-29
Last Update Date:2016-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT24785225100000X
ALPTH7315225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL13765705OtherCAQH
AL511-54880OtherBCBS OF AL
AL511-54877OtherBCBS OF AL
AL511-54879OtherBCBS OF AL
ALP01586196OtherMEDICARE RR
AL511-54878OtherBCBS OF AL
AL13765705OtherCAQH
AL511-54878OtherBCBS OF AL