Provider Demographics
NPI:1225239866
Name:MANNING, ROBERT KEVIN (PHD, CCC-SLP)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:KEVIN
Last Name:MANNING
Suffix:
Gender:M
Credentials:PHD, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3551 ROGER BROOKE DR
Mailing Address - Street 2:
Mailing Address - City:JBSA FT SAM HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:78234-4504
Mailing Address - Country:US
Mailing Address - Phone:210-916-8693
Mailing Address - Fax:210-916-6679
Practice Address - Street 1:3551 ROGER BROOKE
Practice Address - Street 2:BRAIN INJURY REHABILITATION SERVICE
Practice Address - City:JBSA FORT SAM HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:78676-4504
Practice Address - Country:US
Practice Address - Phone:210-916-8693
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-30
Last Update Date:2018-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX17999235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist