Provider Demographics
NPI:1922293364
Name:MANN, THERESA (CRTT/RRTE)
Entity Type:Individual
Prefix:MS
First Name:THERESA
Middle Name:
Last Name:MANN
Suffix:
Gender:F
Credentials:CRTT/RRTE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:73 GLADE CIRCLE DR
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MS
Mailing Address - Zip Code:39443-4722
Mailing Address - Country:US
Mailing Address - Phone:601-427-1663
Mailing Address - Fax:
Practice Address - Street 1:73 GLADE CIRCLE DR
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MS
Practice Address - Zip Code:39443-4722
Practice Address - Country:US
Practice Address - Phone:601-427-1663
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-10
Last Update Date:2007-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN2279E0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2279E0002XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, RegisteredEmergency Care