Provider Demographics
NPI:1972778223
Name:MANNING, MARK C (PTA)
Entity type:Individual
Prefix:MR
First Name:MARK
Middle Name:C
Last Name:MANNING
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:313 E BURKE AVE
Mailing Address - Street 2:APT B
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21286-1140
Mailing Address - Country:US
Mailing Address - Phone:305-766-8767
Mailing Address - Fax:
Practice Address - Street 1:313 E BURKE AVE
Practice Address - Street 2:APT B
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21286-1140
Practice Address - Country:US
Practice Address - Phone:305-766-8767
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-28
Last Update Date:2008-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA2981225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant