Basic Information
Provider Information | |||||||||
NPI: | 1265472674 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | TEAGUE | ||||||||
FirstName: | CHRISTENE | ||||||||
MiddleName: | THANH | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | PT, MSPT | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | TRAN | ||||||||
OtherFirstName: | CHRISTENE | ||||||||
OtherMiddleName: | T | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: | LPT | ||||||||
OtherLastNameType: | 1 | ||||||||
Mailing Information | |||||||||
Address1: | 2531 ROCKY RIDGE RD | ||||||||
Address2: | SUITE 101 | ||||||||
City: | VESTAVIA | ||||||||
State: | AL | ||||||||
PostalCode: | 352434415 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 2059787376 | ||||||||
FaxNumber: | 2059780861 | ||||||||
Practice Location | |||||||||
Address1: | 1713 MONTGOMERY HWY STE 131 | ||||||||
Address2: |   | ||||||||
City: | HOOVER | ||||||||
State: | AL | ||||||||
PostalCode: | 352441254 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 2054038701 | ||||||||
FaxNumber: | 2054038702 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 06/07/2006 | ||||||||
LastUpdateDate: | 04/12/2018 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 1151567 | TX | N |   | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |   | 225100000X | PTH6578 | AL | Y |   | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |   |
No ID Information.