Provider Demographics
NPI:1912145673
Name:MANNO, WENDY J (LMT)
Entity Type:Individual
Prefix:
First Name:WENDY
Middle Name:J
Last Name:MANNO
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:436 CAMDEN CIR
Mailing Address - Street 2:
Mailing Address - City:OSWEGO
Mailing Address - State:IL
Mailing Address - Zip Code:60543-8045
Mailing Address - Country:US
Mailing Address - Phone:630-975-0078
Mailing Address - Fax:630-551-3920
Practice Address - Street 1:436 CAMDEN CIR
Practice Address - Street 2:
Practice Address - City:OSWEGO
Practice Address - State:IL
Practice Address - Zip Code:60543-8045
Practice Address - Country:US
Practice Address - Phone:630-975-0078
Practice Address - Fax:630-551-3920
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-03
Last Update Date:2009-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL227.009226225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist