Provider Demographics
NPI:1649393745
Name:MANN, MICHAEL A (RRT)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:A
Last Name:MANN
Suffix:
Gender:M
Credentials:RRT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 400200
Mailing Address - Street 2:
Mailing Address - City:HESPERIA
Mailing Address - State:CA
Mailing Address - Zip Code:92340-0200
Mailing Address - Country:US
Mailing Address - Phone:855-521-1100
Mailing Address - Fax:760-998-3466
Practice Address - Street 1:14608 MAIN ST
Practice Address - Street 2:STE C
Practice Address - City:HESPERIA
Practice Address - State:CA
Practice Address - Zip Code:92345-3381
Practice Address - Country:US
Practice Address - Phone:855-521-1100
Practice Address - Fax:760-998-3466
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-06
Last Update Date:2017-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORRT-P-10116572227900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes227900000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, Registered