Healthcare Provider Details

I. General information

NPI: 1831004340
Provider Name (Legal Business Name): GRACIE ALEXANDRA MANN DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2026
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

757 UNIVERSITY CITY BLVD
BLACKSBURG VA
24060-2705
US

IV. Provider business mailing address

730 MANN FARM RD
GREENVILLE WV
24945-7146
US

V. Phone/Fax

Practice location:
  • Phone: 540-377-1254
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number003005
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: