Provider Demographics
NPI:1194719989
Name:MANNING, ROBERT D (AUD)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:D
Last Name:MANNING
Suffix:
Gender:M
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1428 N LAKE DR
Mailing Address - Street 2:
Mailing Address - City:PRESTONSBURG
Mailing Address - State:KY
Mailing Address - Zip Code:41653-1293
Mailing Address - Country:US
Mailing Address - Phone:606-886-3773
Mailing Address - Fax:606-886-9124
Practice Address - Street 1:1428 N LAKE DR
Practice Address - Street 2:
Practice Address - City:PRESTONSBURG
Practice Address - State:KY
Practice Address - Zip Code:41653-1293
Practice Address - Country:US
Practice Address - Phone:606-886-3773
Practice Address - Fax:606-886-9124
Is Sole Proprietor?:No
Enumeration Date:2005-09-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY89231H00000X
KY240237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Not Answered237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY3016701Medicare ID - Type Unspecified
KYR39872Medicare UPIN