Provider Demographics
NPI:1972506400
Name:MANN, CHRISTA L (OTR L, CHT)
Entity Type:Individual
Prefix:MRS
First Name:CHRISTA
Middle Name:L
Last Name:MANN
Suffix:
Gender:F
Credentials:OTR L, CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2204 LAKESHORE DR
Mailing Address - Street 2:STE 150
Mailing Address - City:HOMEWOOD
Mailing Address - State:AL
Mailing Address - Zip Code:35209-6729
Mailing Address - Country:US
Mailing Address - Phone:205-423-9502
Mailing Address - Fax:205-423-9504
Practice Address - Street 1:2204 LAKESHORE DR
Practice Address - Street 2:STE 150
Practice Address - City:HOMEWOOD
Practice Address - State:AL
Practice Address - Zip Code:35209-6729
Practice Address - Country:US
Practice Address - Phone:205-423-9502
Practice Address - Fax:205-423-9504
Is Sole Proprietor?:No
Enumeration Date:2005-05-30
Last Update Date:2009-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL0770174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL7357418OtherAETNA
AL51514150OtherBLUE CROSS BLUE SHIELD
AL051514150Medicare PIN
AL7357418OtherAETNA
ALP81519Medicare UPIN