Provider Demographics
NPI:1487866083
Name:MCMANUS, KIM (ATC)
Entity Type:Individual
Prefix:MRS
First Name:KIM
Middle Name:
Last Name:MCMANUS
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 RENAISSANCE WOODS CT
Mailing Address - Street 2:
Mailing Address - City:XENIA
Mailing Address - State:OH
Mailing Address - Zip Code:45385-8703
Mailing Address - Country:US
Mailing Address - Phone:937-376-3463
Mailing Address - Fax:937-347-2911
Practice Address - Street 1:25 RENAISSANCE WOODS CT
Practice Address - Street 2:
Practice Address - City:XENIA
Practice Address - State:OH
Practice Address - Zip Code:45385-8703
Practice Address - Country:US
Practice Address - Phone:937-376-3463
Practice Address - Fax:937-347-2911
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAT0018472255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer