Provider Demographics
NPI:1891837589
Name:MANSO, CHRISTIE L (PT)
Entity Type:Individual
Prefix:MRS
First Name:CHRISTIE
Middle Name:L
Last Name:MANSO
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MISS
Other - First Name:CHRISTIE
Other - Middle Name:L
Other - Last Name:CAMPBELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:15955 NEW HALLS FERRY RD
Mailing Address - Street 2:
Mailing Address - City:FLORISSANT
Mailing Address - State:MO
Mailing Address - Zip Code:63031-1227
Mailing Address - Country:US
Mailing Address - Phone:314-953-5000
Mailing Address - Fax:
Practice Address - Street 1:5323 VILLE MARIA LN
Practice Address - Street 2:
Practice Address - City:HAZELWOOD
Practice Address - State:MO
Practice Address - Zip Code:63042-1143
Practice Address - Country:US
Practice Address - Phone:314-770-2234
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO02162225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist