Provider Demographics
NPI:1992104178
Name:MCMANNES, SEAN PRESCOTT (MAT, ATC)
Entity type:Individual
Prefix:
First Name:SEAN
Middle Name:PRESCOTT
Last Name:MCMANNES
Suffix:
Gender:M
Credentials:MAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2160 S LINMAR CT
Mailing Address - Street 2:
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86001-2923
Mailing Address - Country:US
Mailing Address - Phone:928-821-3497
Mailing Address - Fax:
Practice Address - Street 1:4125 E MCKELLIPS RD
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85215-2411
Practice Address - Country:US
Practice Address - Phone:928-821-3497
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-14
Last Update Date:2014-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ12642255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer