Provider Demographics
NPI:1295988640
Name:MANI, VIJAYAKALA (PA-C)
Entity type:Individual
Prefix:MRS
First Name:VIJAYAKALA
Middle Name:
Last Name:MANI
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1200
Mailing Address - Street 2:
Mailing Address - City:COLLEYVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:76034-1200
Mailing Address - Country:US
Mailing Address - Phone:972-203-3600
Mailing Address - Fax:
Practice Address - Street 1:2895 LEWIS LN
Practice Address - Street 2:
Practice Address - City:PARIS
Practice Address - State:TX
Practice Address - Zip Code:75460-9331
Practice Address - Country:US
Practice Address - Phone:972-203-3600
Practice Address - Fax:972-203-3601
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-29
Last Update Date:2022-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP09858208100000X
TXPA09858363A00000X, 208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Multi-Specialty
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant