MEDICARE: MRS. KATRINA JEANNE MANOS DPM

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	213ES0103X	Foot & Ankle Surgery Podiatrist	1235	MA
2	213ES0103X	Foot & Ankle Surgery Podiatrist	006474	NY

General Provider Information

NPI Number	:	1770710683
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KATRINA JEANNE MANOS DPM

Provider Business Mailing Address
First Line	:	2236 RIDGE RD. W
Second Line	:
City	:	ROCHESTER
State	:	NY
Zip	:	14626-2804
Country	:	US
Telephone Number	:	585-225-2290
Fax Number	:	585-225-1367

Provider Business Practice Location Address
First Line	:	2236 RIDGE RD W.
Second Line	:
City	:	ROCHESTER
State	:	NY
Zip	:	14626-2804
Country	:	US
Telephone Number	:	585-225-2290
Fax Number	:	585-225-1367

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

Provider Enumeration Date	:	06/18/2009
Last Update Date	:	01/03/2017

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