Provider Demographics
NPI:1336756212
Name:MANOCCHIO, CHARLES (DPT, PT)
Entity type:Individual
Prefix:
First Name:CHARLES
Middle Name:
Last Name:MANOCCHIO
Suffix:
Gender:M
Credentials:DPT, PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1305 SE ARMOUR RD STE 110
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97702-3467
Mailing Address - Country:US
Mailing Address - Phone:541-389-4401
Mailing Address - Fax:
Practice Address - Street 1:1305 SE ARMOUR RD STE 110
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97702-3467
Practice Address - Country:US
Practice Address - Phone:541-389-4401
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-25
Last Update Date:2025-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR65876225100000X
WAPT61087301225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist