Provider Demographics
NPI:1457736571
Name:MANNING, NICHOLE (PT)
Entity Type:Individual
Prefix:
First Name:NICHOLE
Middle Name:
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 1:250 12TH AVE STE 160
Mailing Address - Street 2:
Mailing Address - City:CORALVILLE
Mailing Address - State:IA
Mailing Address - Zip Code:52241-2912
Mailing Address - Country:US
Mailing Address - Phone:319-345-4800
Mailing Address - Fax:319-345-4819
Practice Address - Street 1:250 12TH AVE STE 160
Practice Address - Street 2:
Practice Address - City:CORALVILLE
Practice Address - State:IA
Practice Address - Zip Code:52241-2912
Practice Address - Country:US
Practice Address - Phone:319-354-4800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-30
Last Update Date:2016-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA078134225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAIB1212042Medicare PIN
IAIB1212Medicare PIN
IAIB1213046Medicare PIN
IAIB1213Medicare PIN