Provider Demographics
NPI:1689041790
Name:MANZO, LIZBETH (PTA)
Entity Type:Individual
Prefix:
First Name:LIZBETH
Middle Name:
Last Name:MANZO
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7407 TALL PINES DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77088-6607
Mailing Address - Country:US
Mailing Address - Phone:832-526-8124
Mailing Address - Fax:
Practice Address - Street 1:14825 NW FWY STE 800
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77040-4081
Practice Address - Country:US
Practice Address - Phone:281-890-0001
Practice Address - Fax:281-890-1058
Is Sole Proprietor?:No
Enumeration Date:2015-08-24
Last Update Date:2015-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2108067225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant