Provider Demographics
NPI:1346974722
Name:MANUEL, DAVID RAY (ATC/LAT)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:RAY
Last Name:MANUEL
Suffix:
Gender:M
Credentials:ATC/LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:942 N JOHN WAY
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85225-9026
Mailing Address - Country:US
Mailing Address - Phone:480-244-0826
Mailing Address - Fax:
Practice Address - Street 1:2425 N 26TH ST
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85008-1905
Practice Address - Country:US
Practice Address - Phone:602-265-4707
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-12
Last Update Date:2022-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZATTL-0003252255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer