Provider Demographics
NPI:1669255915
Name:MANZELLA, KIMBERLYN SHAYE (PT, DPT)
Entity type:Individual
Prefix:
First Name:KIMBERLYN
Middle Name:SHAYE
Last Name:MANZELLA
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:KIMBERLYN
Other - Middle Name:SHAYE
Other - Last Name:GLENN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9107 MILWAUKEE AVE
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79424-0921
Mailing Address - Country:US
Mailing Address - Phone:806-687-4311
Mailing Address - Fax:806-687-4313
Practice Address - Street 1:9107 MILWAUKEE AVE
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79424-0921
Practice Address - Country:US
Practice Address - Phone:806-687-4311
Practice Address - Fax:806-687-4313
Is Sole Proprietor?:No
Enumeration Date:2023-08-18
Last Update Date:2023-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist