Provider Demographics
NPI:1023157989
Name:MANAM, KUMAR (PT,PHD)
Entity type:Individual
Prefix:
First Name:KUMAR
Middle Name:
Last Name:MANAM
Suffix:
Gender:M
Credentials:PT,PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8327 OXFORD LN
Mailing Address - Street 2:
Mailing Address - City:GRAND BLANC
Mailing Address - State:MI
Mailing Address - Zip Code:48439-7449
Mailing Address - Country:US
Mailing Address - Phone:810-695-8689
Mailing Address - Fax:
Practice Address - Street 1:8327 OXFORD LN
Practice Address - Street 2:
Practice Address - City:GRAND BLANC
Practice Address - State:MI
Practice Address - Zip Code:48439-7449
Practice Address - Country:US
Practice Address - Phone:810-695-8689
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-06
Last Update Date:2007-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501011016225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist