Provider Demographics
NPI:1982718177
Name:MANKA, KATIE LYNN (LAT)
Entity type:Individual
Prefix:MISS
First Name:KATIE
Middle Name:LYNN
Last Name:MANKA
Suffix:
Gender:F
Credentials:LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3951 E KLIEFORTH AVE
Mailing Address - Street 2:
Mailing Address - City:CUDAHY
Mailing Address - State:WI
Mailing Address - Zip Code:53110-3123
Mailing Address - Country:US
Mailing Address - Phone:414-483-2933
Mailing Address - Fax:
Practice Address - Street 1:300 MC CANNA PKWY
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:WI
Practice Address - Zip Code:53105-3622
Practice Address - Country:US
Practice Address - Phone:262-767-7160
Practice Address - Fax:262-767-7127
Is Sole Proprietor?:No
Enumeration Date:2006-08-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer