Provider Demographics
NPI:1144634908
Name:GEORGE, MANOJ
Entity type:Individual
Prefix:
First Name:MANOJ
Middle Name:
Last Name:GEORGE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10760 SW 11TH DR
Mailing Address - Street 2:NONE
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33324-4153
Mailing Address - Country:US
Mailing Address - Phone:954-805-5315
Mailing Address - Fax:
Practice Address - Street 1:10760 SW 11TH DR
Practice Address - Street 2:NONE
Practice Address - City:DAVIE
Practice Address - State:FL
Practice Address - Zip Code:33324-4153
Practice Address - Country:US
Practice Address - Phone:954-805-5315
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-19
Last Update Date:2014-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRT 123122279H0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2279H0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, RegisteredHome Health