Provider Demographics
NPI:1568740116
Name:MANNING, BRENT M (ATP)
Entity Type:Individual
Prefix:MR
First Name:BRENT
Middle Name:M
Last Name:MANNING
Suffix:
Gender:M
Credentials:ATP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2325 S 77 SUNSHINESTRIP STE B
Mailing Address - Street 2:
Mailing Address - City:HARLINGEN
Mailing Address - State:TX
Mailing Address - Zip Code:78550-8356
Mailing Address - Country:US
Mailing Address - Phone:956-412-9100
Mailing Address - Fax:956-412-9105
Practice Address - Street 1:2325 S 77 SUNSHINESTRIP STE B
Practice Address - Street 2:
Practice Address - City:HARLINGEN
Practice Address - State:TX
Practice Address - Zip Code:78550-8356
Practice Address - Country:US
Practice Address - Phone:956-412-9100
Practice Address - Fax:956-412-9105
Is Sole Proprietor?:No
Enumeration Date:2011-08-01
Last Update Date:2011-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXATP42118247200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other