Provider Demographics
NPI:1770887895
Name:MANNING, MEGAN MARY (PT)
Entity type:Individual
Prefix:MRS
First Name:MEGAN
Middle Name:MARY
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 1:120 CEDARHURST AVE
Mailing Address - Street 2:
Mailing Address - City:POINT LOOKOUT
Mailing Address - State:NY
Mailing Address - Zip Code:11569-3014
Mailing Address - Country:US
Mailing Address - Phone:516-642-1527
Mailing Address - Fax:
Practice Address - Street 1:120 CEDARHURST AVE
Practice Address - Street 2:
Practice Address - City:POINT LOOKOUT
Practice Address - State:NY
Practice Address - Zip Code:11569-3014
Practice Address - Country:US
Practice Address - Phone:516-642-1527
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-04
Last Update Date:2011-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012781-12251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics