Provider Demographics
NPI:1639390669
Name:ROBERT D. MANNING
Entity Type:Organization
Organization Name:ROBERT D. MANNING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:MANNING
Authorized Official - Suffix:
Authorized Official - Credentials:AUD
Authorized Official - Phone:606-886-3773
Mailing Address - Street 1:1428 N LAKE DR
Mailing Address - Street 2:
Mailing Address - City:PRESTONSBURG
Mailing Address - State:KY
Mailing Address - Zip Code:41653-1293
Mailing Address - Country:US
Mailing Address - Phone:606-886-3773
Mailing Address - Fax:606-886-9124
Practice Address - Street 1:1428 N LAKE DR
Practice Address - Street 2:
Practice Address - City:PRESTONSBURG
Practice Address - State:KY
Practice Address - Zip Code:41653-1293
Practice Address - Country:US
Practice Address - Phone:606-886-3773
Practice Address - Fax:606-886-9124
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY0089231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY3016701Medicare ID - Type Unspecified
KYR39872Medicare UPIN