Healthcare Provider Details

I. General information

NPI: 1932147923
Provider Name (Legal Business Name): ROSS MANSKER P.T.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/03/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

128 N COMMERCE ST
PORT LAVACA TX
77979-3435
US

IV. Provider business mailing address

602 COLONY CREEK DR
VICTORIA TX
77904-3806
US

V. Phone/Fax

Practice location:
  • Phone: 361-552-1977
  • Fax: 361-552-7686
Mailing address:
  • Phone: 361-552-1977
  • Fax: 361-552-7686

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number1048940
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: