MEDICARE: DIANE JOYCE MANNING

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	PT27975	FL

General Provider Information

NPI Number	:	1336510825
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DIANE JOYCE MANNING

Provider Business Mailing Address
First Line	:	5090 FAIRWAYS CIR
Second Line	:	APT 205
City	:	VERO BEACH
State	:	FL
Zip	:	32967-7437
Country	:	US
Telephone Number	:	646-289-2921
Fax Number	:

Provider Business Practice Location Address
First Line	:	2180 10TH AVE
Second Line	:
City	:	VERO BEACH
State	:	FL
Zip	:	32960-5399
Country	:	US
Telephone Number	:	772-567-5166
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/09/2015
Last Update Date	:	03/31/2016

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