Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant |
NPI | 1003103573 |
---|---|
Provider Name | Ms. Debra Manyen |
First Address | Bay City, MI 48706-2161 |
Second Address | Bay City, MI 48706-2161 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/07/2011 |
Last Update Date | 06/07/2011 |