=====================================================
General NPI Number Information
=====================================================
NPI Number | 1073303210
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LARRY ANTHONY MANARO MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/09/2025
-----------------------------------------------------
Last Update Date | 05/09/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1700 S 23RD ST
-----------------------------------------------------
City | FORT PIERCE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34950-4803
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 772-461-4000
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2165 OHLTOWN MCDONALD RD
-----------------------------------------------------
City | MC DONALD
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44437-1317
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 330-727-2287
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 390200000X
-----------------------------------------------------
Taxonomy Name | Student in an Organized Health Care Education/Training Program
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------