Provider Demographics
NPI:1265472674
Name:TEAGUE, CHRISTENE THANH (PT, MSPT)
Entity Type:Individual
Prefix:
First Name:CHRISTENE
Middle Name:THANH
Last Name:TEAGUE
Suffix:
Gender:F
Credentials:PT, MSPT
Other - Prefix:
Other - First Name:CHRISTENE
Other - Middle Name:T
Other - Last Name:TRAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPT
Mailing Address - Street 1:2531 ROCKY RIDGE RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:VESTAVIA
Mailing Address - State:AL
Mailing Address - Zip Code:35243-4415
Mailing Address - Country:US
Mailing Address - Phone:205-978-7376
Mailing Address - Fax:205-978-0861
Practice Address - Street 1:1713 MONTGOMERY HWY STE 131
Practice Address - Street 2:
Practice Address - City:HOOVER
Practice Address - State:AL
Practice Address - Zip Code:35244-1254
Practice Address - Country:US
Practice Address - Phone:205-403-8701
Practice Address - Fax:205-403-8702
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2018-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1151567225100000X
ALPTH6578225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL102I650947Medicare Oscar/Certification