Provider Demographics
NPI:1003956814
Name:MANES, CYNTHIA ANN (PT)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:ANN
Last Name:MANES
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1218 DOGWOOD ST
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75701-5236
Mailing Address - Country:US
Mailing Address - Phone:903-245-6632
Mailing Address - Fax:903-531-2451
Practice Address - Street 1:305 S BROADWAY AVE
Practice Address - Street 2:500
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75702-7307
Practice Address - Country:US
Practice Address - Phone:903-245-6632
Practice Address - Fax:903-531-2451
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-08
Last Update Date:2007-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1053130225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist