Provider Demographics
NPI:1790726966
Name:MANNING, KATHY LEE (PT)
Entity Type:Individual
Prefix:
First Name:KATHY
Middle Name:LEE
Last Name:MANNING
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 HICKORY DR
Mailing Address - Street 2:
Mailing Address - City:VICTORIA
Mailing Address - State:TX
Mailing Address - Zip Code:77904-4630
Mailing Address - Country:US
Mailing Address - Phone:361-572-4246
Mailing Address - Fax:361-572-9490
Practice Address - Street 1:115 MEDICAL DR
Practice Address - Street 2:SUITE 207
Practice Address - City:VICTORIA
Practice Address - State:TX
Practice Address - Zip Code:77904-3173
Practice Address - Country:US
Practice Address - Phone:361-572-4246
Practice Address - Fax:361-572-9490
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1037539225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX456655Medicare ID - Type Unspecified