Provider Demographics
NPI:1932476157
Name:MANLEY, AMELIA LAURA (PT)
Entity Type:Individual
Prefix:MRS
First Name:AMELIA
Middle Name:LAURA
Last Name:MANLEY
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 1:135 GOSHEN ROAD EXT
Mailing Address - Street 2:SUITE 206
Mailing Address - City:RINCON
Mailing Address - State:GA
Mailing Address - Zip Code:31326-5567
Mailing Address - Country:US
Mailing Address - Phone:877-826-1509
Mailing Address - Fax:
Practice Address - Street 1:135 GOSHEN ROAD EXT
Practice Address - Street 2:SUITE 206
Practice Address - City:RINCON
Practice Address - State:GA
Practice Address - Zip Code:31326-5567
Practice Address - Country:US
Practice Address - Phone:877-826-1509
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-17
Last Update Date:2011-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT008034225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist