Individual
MR. THEODIS ROOSEVELT MANNING
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
B.S. ENGINEERING
Contact information
Practice address
8306 NE 10TH ST, MIDWEST CITY, OK 73110-7155
(405) 732-0573
Mailing address
8306 NE 10TH ST, MIDWEST CITY, OK 73110-7155
(405) 732-0573
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00000000000000000000
N/A
OK
Enumeration date
08/01/2011
Last updated
04/05/2024
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