Individual
MR. JERRY WAYNE MANNING
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT
Contact information
Practice address
3016 W MAIN ST STE 200, RUSSELLVILLE, AR 72801-2453
(479) 967-9657
(479) 967-9658
Mailing address
3016 W MAIN ST STE 200, RUSSELLVILLE, AR 72801-2453
(479) 967-9657
(479) 967-9658
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
04847R
LA
225100000X
Physical Therapist
Primary
PT2457
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1139955
—
LA
Enumeration date
09/30/2005
Last updated
09/19/2023
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