Provider Demographics
NPI:1225316706
Name:MANNING, THEODIS ROOSEVELT (BS ENGINEERING)
Entity Type:Individual
Prefix:MR
First Name:THEODIS
Middle Name:ROOSEVELT
Last Name:MANNING
Suffix:
Gender:M
Credentials:BS ENGINEERING
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8306 NE 10TH ST
Mailing Address - Street 2:
Mailing Address - City:MIDWEST CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73110-7155
Mailing Address - Country:US
Mailing Address - Phone:405-732-0573
Mailing Address - Fax:
Practice Address - Street 1:8306 NE 10TH ST
Practice Address - Street 2:
Practice Address - City:MIDWEST CITY
Practice Address - State:OK
Practice Address - Zip Code:73110-7155
Practice Address - Country:US
Practice Address - Phone:405-732-0573
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-01
Last Update Date:2024-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK00000000000000000000OtherN/A