Provider Demographics
NPI:1306905732
Name:MANUEL, TY J (HHS)
Entity type:Individual
Prefix:MR
First Name:TY
Middle Name:J
Last Name:MANUEL
Suffix:
Gender:M
Credentials:HHS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1526
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:TX
Mailing Address - Zip Code:77631-1526
Mailing Address - Country:US
Mailing Address - Phone:409-892-9091
Mailing Address - Fax:409-892-9090
Practice Address - Street 1:4030 DOWLEN RD STE 6
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77706-6878
Practice Address - Country:US
Practice Address - Phone:409-892-9091
Practice Address - Fax:409-892-9090
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-08
Last Update Date:2008-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX50322237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX180555801Medicaid