Provider Demographics
NPI:1598211500
Name:MANN, MALIA RAE (DPT)
Entity Type:Individual
Prefix:
First Name:MALIA
Middle Name:RAE
Last Name:MANN
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:902 W ERIE PLZ
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16505-4536
Mailing Address - Country:US
Mailing Address - Phone:814-456-6000
Mailing Address - Fax:814-456-6060
Practice Address - Street 1:902 W ERIE PLZ
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16505-4536
Practice Address - Country:US
Practice Address - Phone:814-456-6000
Practice Address - Fax:814-456-6060
Is Sole Proprietor?:No
Enumeration Date:2016-08-30
Last Update Date:2016-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT025204225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA543790V9GMedicare UPIN