Provider Demographics
NPI:1033401013
Name:MANKINS, AARON DWAIN
Entity type:Individual
Prefix:
First Name:AARON
Middle Name:DWAIN
Last Name:MANKINS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:AARON
Other - Middle Name:
Other - Last Name:MANKINS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMT
Mailing Address - Street 1:PO BOX 1452
Mailing Address - Street 2:
Mailing Address - City:NEWBERRY
Mailing Address - State:FL
Mailing Address - Zip Code:32669
Mailing Address - Country:US
Mailing Address - Phone:352-672-5206
Mailing Address - Fax:
Practice Address - Street 1:25355 W NEWBERRY RD
Practice Address - Street 2:
Practice Address - City:NEWBERRY
Practice Address - State:FL
Practice Address - Zip Code:32669-4253
Practice Address - Country:US
Practice Address - Phone:352-672-5206
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-09
Last Update Date:2011-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA 62915225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist