Provider Demographics
NPI:1386934818
Name:MANYAK, STEPHANIE RAE (ATC)
Entity type:Individual
Prefix:MS
First Name:STEPHANIE
Middle Name:RAE
Last Name:MANYAK
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 1:949 MORGAN BAY RD
Mailing Address - Street 2:
Mailing Address - City:BLUE HILL
Mailing Address - State:ME
Mailing Address - Zip Code:04614-5517
Mailing Address - Country:US
Mailing Address - Phone:207-479-5228
Mailing Address - Fax:
Practice Address - Street 1:949 MORGAN BAY RD
Practice Address - Street 2:
Practice Address - City:BLUE HILL
Practice Address - State:ME
Practice Address - Zip Code:04614-5517
Practice Address - Country:US
Practice Address - Phone:207-479-5228
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-18
Last Update Date:2011-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
20000023792255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer