Provider Demographics
NPI:1801020540
Name:MANNING, LORI JEAN (COTA)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:JEAN
Last Name:MANNING
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 E QUINCY ST
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78215-1934
Mailing Address - Country:US
Mailing Address - Phone:210-472-2011
Mailing Address - Fax:210-472-0214
Practice Address - Street 1:400 E QUINCY ST
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78215-1934
Practice Address - Country:US
Practice Address - Phone:210-472-2011
Practice Address - Fax:210-472-0214
Is Sole Proprietor?:No
Enumeration Date:2009-05-10
Last Update Date:2009-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX206607171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor