Provider Demographics
NPI:1164944708
Name:MANUEL, MAYO MANAHAN (PT)
Entity Type:Individual
Prefix:
First Name:MAYO
Middle Name:MANAHAN
Last Name:MANUEL
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 2ND ST SE FL 33880
Mailing Address - Street 2:
Mailing Address - City:WINTER HAVEN
Mailing Address - State:FL
Mailing Address - Zip Code:33880-6300
Mailing Address - Country:US
Mailing Address - Phone:863-293-2107
Mailing Address - Fax:863-595-4250
Practice Address - Street 1:50 2ND ST SE FL 33880
Practice Address - Street 2:
Practice Address - City:WINTER HAVEN
Practice Address - State:FL
Practice Address - Zip Code:33880-6300
Practice Address - Country:US
Practice Address - Phone:863-293-2107
Practice Address - Fax:863-595-4250
Is Sole Proprietor?:No
Enumeration Date:2017-07-14
Last Update Date:2019-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT162992251N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251N0400XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistNeurology