Provider Demographics
NPI:1316373640
Name:MANLEY, MATTHEW ALAN (MASSAGE PRACTITIONER)
Entity Type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:ALAN
Last Name:MANLEY
Suffix:
Gender:M
Credentials:MASSAGE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Mailing Address - Street 1:7211 W DESCHUTES AVE
Mailing Address - Street 2:D202
Mailing Address - City:KENNEWICK
Mailing Address - State:WA
Mailing Address - Zip Code:99336-7728
Mailing Address - Country:US
Mailing Address - Phone:509-222-1112
Mailing Address - Fax:
Practice Address - Street 1:7211 W DESCHUTES AVE
Practice Address - Street 2:D202
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99336-7728
Practice Address - Country:US
Practice Address - Phone:509-222-1112
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-18
Last Update Date:2013-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60404502225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist