Provider Demographics
NPI:1700406030
Name:MANOR, SCOTT ALLEN
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:ALLEN
Last Name:MANOR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2500 COX RD
Mailing Address - Street 2:
Mailing Address - City:MILLSAP
Mailing Address - State:TX
Mailing Address - Zip Code:76066-2853
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2500 COX RD
Practice Address - Street 2:
Practice Address - City:MILLSAP
Practice Address - State:TX
Practice Address - Zip Code:76066-2853
Practice Address - Country:US
Practice Address - Phone:682-258-1998
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-16
Last Update Date:2020-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1299730261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy