Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208100000X | Physical Medicine & Rehabilitation Doctor | 0131001639 | VA |
NPI | 1053878587 |
---|---|
Provider Name | Mrs. Mary Kate Manuel |
First Address | Lynchburg, VA 24502-4395 |
Second Address | Bedford, VA 24523-1213 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/02/2019 |
Last Update Date | 20/02/2019 |