Stephanie Rae Manyak, ATC
Individual provider Active NPI Athletic Trainer · Blue Hill, ME
NPI 1386934818 · NPPES record last updated Apr 18, 2011
Key facts
- NPI
- 1386934818
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Athletic Trainer 2255A2300X
- License
- 2000002379
- Practice address
- 949 Morgan Bay Rd
Blue Hill, ME 04614-5517 - Phone
- (207) 479-5228
- NPI assigned
- Apr 18, 2011
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Athletic Trainer | 2255A2300X | 2000002379 | Yes |
Addresses
Primary practice location
949 Morgan Bay Rd
Blue Hill, ME 04614-5517
Mailing address
949 Morgan Bay Rd
Blue Hill, ME 04614-5517
Phone (207) 479-5228
Other providers in Blue Hill, ME
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 18, 2011. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.