Provider Demographics
NPI:1366119083
Name:MANLEY, CODY (PA-C)
Entity type:Individual
Prefix:
First Name:CODY
Middle Name:
Last Name:MANLEY
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 266
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:IN
Mailing Address - Zip Code:47842-0266
Mailing Address - Country:US
Mailing Address - Phone:765-832-9301
Mailing Address - Fax:765-832-9302
Practice Address - Street 1:819 S 3RD ST
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:IN
Practice Address - Zip Code:47842-2205
Practice Address - Country:US
Practice Address - Phone:765-832-2464
Practice Address - Fax:765-832-1638
Is Sole Proprietor?:No
Enumeration Date:2021-08-30
Last Update Date:2021-08-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN10003351A363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant