Provider Demographics
NPI:1427775014
Name:MCKINNEY MANNING, MICHELLE (LMBT, CMLDT)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:MCKINNEY MANNING
Suffix:
Gender:F
Credentials:LMBT, CMLDT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:417 FOREST HILL AVE
Mailing Address - Street 2:
Mailing Address - City:ROCKY MOUNT
Mailing Address - State:NC
Mailing Address - Zip Code:27804-3735
Mailing Address - Country:US
Mailing Address - Phone:252-813-7221
Mailing Address - Fax:
Practice Address - Street 1:1151 FALLS RD STE 2026
Practice Address - Street 2:
Practice Address - City:ROCKY MOUNT
Practice Address - State:NC
Practice Address - Zip Code:27804-4429
Practice Address - Country:US
Practice Address - Phone:252-813-7221
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-24
Last Update Date:2022-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC15551225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC15551OtherLMBT STATE LICENSE MASSAGE BOARD