Provider Demographics
NPI:1306000450
Name:MANSELL, KRISTINA L (DPT)
Entity type:Individual
Prefix:
First Name:KRISTINA
Middle Name:L
Last Name:MANSELL
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1272 COLEY CREEK RD
Mailing Address - Street 2:
Mailing Address - City:ALEXANDER CITY
Mailing Address - State:AL
Mailing Address - Zip Code:35010-7547
Mailing Address - Country:US
Mailing Address - Phone:440-476-2541
Mailing Address - Fax:
Practice Address - Street 1:3316 HIGHWAY 280
Practice Address - Street 2:RUSSELL MEDICAL CENTER
Practice Address - City:ALEXANDER CITY
Practice Address - State:AL
Practice Address - Zip Code:35010-7547
Practice Address - Country:US
Practice Address - Phone:440-476-2541
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-17
Last Update Date:2008-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL23749225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist