Provider Demographics
NPI:1447285309
Name:FOUNTAIN, CHRISTOPHER J (PT, OCS, MTC)
Entity type:Individual
Prefix:MR
First Name:CHRISTOPHER
Middle Name:J
Last Name:FOUNTAIN
Suffix:
Gender:M
Credentials:PT, OCS, MTC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3234 CAHABA HEIGHTS RD
Mailing Address - Street 2:
Mailing Address - City:VESTAVIA
Mailing Address - State:AL
Mailing Address - Zip Code:35243-1614
Mailing Address - Country:US
Mailing Address - Phone:205-298-9101
Mailing Address - Fax:205-298-9103
Practice Address - Street 1:3234 CAHABA HEIGHTS RD
Practice Address - Street 2:
Practice Address - City:VESTAVIA
Practice Address - State:AL
Practice Address - Zip Code:35243
Practice Address - Country:US
Practice Address - Phone:205-298-9101
Practice Address - Fax:205-298-9103
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2018-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPTH3863225100000X, 2251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL890016350Medicaid
AL51530042OtherBCBS OF AL
AL7060773OtherAETNA
AL7060773Medicare UPIN