Provider Demographics
NPI:1134517766
Name:MANNING, WILLLIAM ALEXANDER
Entity Type:Individual
Prefix:
First Name:WILLLIAM
Middle Name:ALEXANDER
Last Name:MANNING
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:251 WESTGATE DR
Mailing Address - Street 2:
Mailing Address - City:TRINIDAD
Mailing Address - State:CA
Mailing Address - Zip Code:95570-9707
Mailing Address - Country:US
Mailing Address - Phone:707-502-8878
Mailing Address - Fax:
Practice Address - Street 1:251 WESTGATE DR
Practice Address - Street 2:
Practice Address - City:TRINIDAD
Practice Address - State:CA
Practice Address - Zip Code:95570-9707
Practice Address - Country:US
Practice Address - Phone:707-502-8878
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-06
Last Update Date:2015-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAT 4884225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant