Provider Demographics
NPI:1760760615
Name:MANNING, HEATHER L (DPT)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:L
Last Name:MANNING
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 1:315 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:SALAMANCA
Mailing Address - State:NY
Mailing Address - Zip Code:14779-1062
Mailing Address - Country:US
Mailing Address - Phone:716-378-8569
Mailing Address - Fax:
Practice Address - Street 1:400 INTERNATIONAL PKWY
Practice Address - Street 2:STE., 300
Practice Address - City:LAKE MARY
Practice Address - State:FL
Practice Address - Zip Code:32746-5061
Practice Address - Country:US
Practice Address - Phone:407-833-8815
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-26
Last Update Date:2011-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY033612225100000X
PAPT021400225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist