Provider Demographics
NPI:1679967939
Name:MCMANIS, KIMBERLY A (ATC)
Entity type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:A
Last Name:MCMANIS
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 1:116 HOY ST
Mailing Address - Street 2:
Mailing Address - City:RICES LANDING
Mailing Address - State:PA
Mailing Address - Zip Code:15357-1181
Mailing Address - Country:US
Mailing Address - Phone:814-243-4397
Mailing Address - Fax:
Practice Address - Street 1:316 WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:WHEELING
Practice Address - State:WV
Practice Address - Zip Code:26003-6243
Practice Address - Country:US
Practice Address - Phone:304-243-2204
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-25
Last Update Date:2015-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer