Provider Demographics
NPI:1699066654
Name:MANNING, AMY N (DPT)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:N
Last Name:MANNING
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:N
Other - Last Name:LILLY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:959 GREEN VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:BRIDGEPORT
Mailing Address - State:WV
Mailing Address - Zip Code:26330-9815
Mailing Address - Country:US
Mailing Address - Phone:304-641-7116
Mailing Address - Fax:
Practice Address - Street 1:109-B DOCTOR'S DRIVE
Practice Address - Street 2:
Practice Address - City:BRIDGEPORT
Practice Address - State:WV
Practice Address - Zip Code:26330-0000
Practice Address - Country:US
Practice Address - Phone:304-842-7720
Practice Address - Fax:304-842-7722
Is Sole Proprietor?:No
Enumeration Date:2011-04-26
Last Update Date:2015-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVPENDING225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist