Provider Demographics
NPI:1932147923
Name:MANSKER, ROSS (PT)
Entity Type:Individual
Prefix:MR
First Name:ROSS
Middle Name:
Last Name:MANSKER
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:602 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:361-552-1977
Mailing Address - Fax:361-552-7686
Practice Address - Street 1:128 N COMMERCE ST
Practice Address - Street 2:
Practice Address - City:PORT LAVACA
Practice Address - State:TX
Practice Address - Zip Code:77979-3435
Practice Address - Country:US
Practice Address - Phone:361-552-1977
Practice Address - Fax:361-552-7686
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1048940225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX456655Medicare ID - Type Unspecified