Provider Demographics
NPI:1306219076
Name:MANWARING, ANGELA MARIE (PT)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:MARIE
Last Name:MANWARING
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13022 LULU RD
Mailing Address - Street 2:
Mailing Address - City:IDA
Mailing Address - State:MI
Mailing Address - Zip Code:48140-9525
Mailing Address - Country:US
Mailing Address - Phone:734-735-5830
Mailing Address - Fax:
Practice Address - Street 1:730 KIMOLE LN
Practice Address - Street 2:
Practice Address - City:ADRIAN
Practice Address - State:MI
Practice Address - Zip Code:49221-1463
Practice Address - Country:US
Practice Address - Phone:517-263-6771
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-11-03
Last Update Date:2015-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501007184225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist