Provider Demographics
NPI:1336437805
Name:MANUEL, CORA E (MPT)
Entity Type:Individual
Prefix:
First Name:CORA
Middle Name:E
Last Name:MANUEL
Suffix:
Gender:F
Credentials:MPT
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 98
Mailing Address - Street 2:
Mailing Address - City:MAMOU
Mailing Address - State:LA
Mailing Address - Zip Code:70554-0098
Mailing Address - Country:US
Mailing Address - Phone:337-468-4685
Mailing Address - Fax:337-468-4692
Practice Address - Street 1:1605 7TH ST STE B
Practice Address - Street 2:
Practice Address - City:MAMOU
Practice Address - State:LA
Practice Address - Zip Code:70554-2221
Practice Address - Country:US
Practice Address - Phone:337-468-4685
Practice Address - Fax:337-468-4692
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-18
Last Update Date:2019-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA06432225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist