Provider Demographics
NPI:1902083009
Name:EVANS, CHRISTY BRADBERRY (PT)
Entity Type:Individual
Prefix:
First Name:CHRISTY
Middle Name:BRADBERRY
Last Name:EVANS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:CHRISTY
Other - Middle Name:ANN
Other - Last Name:BRADBERRY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:2980 HIGHWAY 78 E
Mailing Address - Street 2:
Mailing Address - City:JASPER
Mailing Address - State:AL
Mailing Address - Zip Code:35501-8903
Mailing Address - Country:US
Mailing Address - Phone:205-384-1941
Mailing Address - Fax:205-384-6362
Practice Address - Street 1:2980 HIGHWAY 78 E
Practice Address - Street 2:
Practice Address - City:JASPER
Practice Address - State:AL
Practice Address - Zip Code:35501-8903
Practice Address - Country:US
Practice Address - Phone:205-384-1941
Practice Address - Fax:205-384-6362
Is Sole Proprietor?:No
Enumeration Date:2008-01-31
Last Update Date:2023-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-0522225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51546247OtherBLUE CROSS AND BLUE SHIELD OF ALABAMA
AL0879600001Medicare NSC