Provider Demographics
NPI:1073340253
Name:MANN, NIKOLAS BLAKE (LPTA)
Entity type:Individual
Prefix:
First Name:NIKOLAS
Middle Name:BLAKE
Last Name:MANN
Suffix:
Gender:M
Credentials:LPTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2089 CECIL ASHBURN DR SE STE 202
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35802-2569
Mailing Address - Country:US
Mailing Address - Phone:256-248-9482
Mailing Address - Fax:
Practice Address - Street 1:2089 CECIL ASHBURN DR SE STE 202
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35802-2569
Practice Address - Country:US
Practice Address - Phone:256-248-9482
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-19
Last Update Date:2024-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPTA11922225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant