Provider Demographics
NPI:1073614202
Name:MANOR, BOBBY GENE II (LPTA)
Entity Type:Individual
Prefix:MR
First Name:BOBBY
Middle Name:GENE
Last Name:MANOR
Suffix:II
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 1:162 HICKORY TRCE
Mailing Address - Street 2:
Mailing Address - City:LYLES
Mailing Address - State:TN
Mailing Address - Zip Code:37098-9663
Mailing Address - Country:US
Mailing Address - Phone:937-670-4849
Mailing Address - Fax:
Practice Address - Street 1:162 HICKORY TRCE
Practice Address - Street 2:
Practice Address - City:LYLES
Practice Address - State:TN
Practice Address - Zip Code:37098-9663
Practice Address - Country:US
Practice Address - Phone:931-670-4849
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2012225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant