Provider Demographics
NPI:1861849200
Name:MANESS, TERESA LYNN (LPTA)
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:LYNN
Last Name:MANESS
Suffix:
Gender:F
Credentials:LPTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:262 CEDAR AVE
Mailing Address - Street 2:
Mailing Address - City:GATE CITY
Mailing Address - State:VA
Mailing Address - Zip Code:24251-3248
Mailing Address - Country:US
Mailing Address - Phone:423-502-2313
Mailing Address - Fax:
Practice Address - Street 1:262 CEDAR AVE
Practice Address - Street 2:
Practice Address - City:GATE CITY
Practice Address - State:VA
Practice Address - Zip Code:24251-3248
Practice Address - Country:US
Practice Address - Phone:423-502-2313
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-16
Last Update Date:2016-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN5253225200000X
VA2306001164225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant