Provider Demographics
NPI:1285168948
Name:MANUS, MARISA ANN (ATC)
Entity type:Individual
Prefix:
First Name:MARISA
Middle Name:ANN
Last Name:MANUS
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14520 SE 196TH PL
Mailing Address - Street 2:
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98058-9415
Mailing Address - Country:US
Mailing Address - Phone:206-612-9937
Mailing Address - Fax:
Practice Address - Street 1:14520 SE 196TH PL
Practice Address - Street 2:
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98058-9415
Practice Address - Country:US
Practice Address - Phone:206-612-9937
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-19
Last Update Date:2017-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer