Provider Demographics
NPI:1366798068
Name:MANNING, MYCHAL S (DPT)
Entity type:Individual
Prefix:
First Name:MYCHAL
Middle Name:S
Last Name:MANNING
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20460 DEL COCO CT
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97702-9414
Mailing Address - Country:US
Mailing Address - Phone:949-290-5193
Mailing Address - Fax:
Practice Address - Street 1:1725 SW CHANDLER AVE STE 102
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97702-3249
Practice Address - Country:US
Practice Address - Phone:541-209-6729
Practice Address - Fax:541-605-3286
Is Sole Proprietor?:No
Enumeration Date:2012-07-31
Last Update Date:2024-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA39246225100000X
OR60487225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist