Provider Demographics
NPI:1801073861
Name:MANZER, DUANE ALLEN (ATC)
Entity type:Individual
Prefix:MR
First Name:DUANE
Middle Name:ALLEN
Last Name:MANZER
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1102 N 49TH ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68132-1615
Mailing Address - Country:US
Mailing Address - Phone:402-709-8920
Mailing Address - Fax:
Practice Address - Street 1:2700 COLLEGE RD
Practice Address - Street 2:
Practice Address - City:COUNCIL BLUFFS
Practice Address - State:IA
Practice Address - Zip Code:51503-1057
Practice Address - Country:US
Practice Address - Phone:712-256-6556
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-22
Last Update Date:2011-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA6982255A2300X
NE4382255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer