Provider Demographics
NPI:1669581849
Name:MANSKER, JACQUELYN (PT)
Entity type:Individual
Prefix:MRS
First Name:JACQUELYN
Middle Name:
Last Name:MANSKER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MRS
Other - First Name:JACKI
Other - Middle Name:
Other - Last Name:MANSKER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT
Mailing Address - Street 1:602 COLONY CREEK DR
Mailing Address - Street 2:
Mailing Address - City:VICTORIA
Mailing Address - State:TX
Mailing Address - Zip Code:77904-3806
Mailing Address - Country:US
Mailing Address - Phone:361-578-8373
Mailing Address - Fax:
Practice Address - Street 1:5205 JOHN STOCKBAUER DR
Practice Address - Street 2:
Practice Address - City:VICTORIA
Practice Address - State:TX
Practice Address - Zip Code:77904-1866
Practice Address - Country:US
Practice Address - Phone:361-572-4246
Practice Address - Fax:361-572-9490
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2017-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1049047225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist