Individual
MAXIE B MANNING
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
415 S 28TH AVE, HATTIESBURG, MS 39401-7246
(601) 268-5757
(601) 579-5220
Mailing address
415 S 28TH AVE, HATTIESBURG, MS 39401-7246
(601) 268-5757
(601) 579-5240
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT0130
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00124907
—
MS
01
—
2265849
AMERICAN ADMIN GROUP
MS
01
—
P00308442
RAILROAD MEDICARE
MS
Enumeration date
08/19/2006
Last updated
08/23/2016
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