Provider Demographics
NPI:1346933801
Name:MCMANUS, MOLLYE CAMILLE (PT)
Entity type:Individual
Prefix:
First Name:MOLLYE
Middle Name:CAMILLE
Last Name:MCMANUS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4324 S SHERWOOD FOREST BLVD STE B170
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70816-4481
Mailing Address - Country:US
Mailing Address - Phone:225-654-8208
Mailing Address - Fax:225-465-8823
Practice Address - Street 1:17534 OLD JEFFERSON HWY STE A1
Practice Address - Street 2:
Practice Address - City:PRAIRIEVILLE
Practice Address - State:LA
Practice Address - Zip Code:70769-3978
Practice Address - Country:US
Practice Address - Phone:225-673-4370
Practice Address - Fax:225-673-2241
Is Sole Proprietor?:No
Enumeration Date:2023-05-31
Last Update Date:2024-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA11498225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist