Provider Demographics
NPI:1649311903
Name:MANFREDONIA, KAREN ANN (PT)
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:ANN
Last Name:MANFREDONIA
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:673 SHELLEY RENEE LN
Mailing Address - Street 2:
Mailing Address - City:CORDOVA
Mailing Address - State:TN
Mailing Address - Zip Code:38018-4366
Mailing Address - Country:US
Mailing Address - Phone:310-977-6674
Mailing Address - Fax:
Practice Address - Street 1:673 SHELLEY RENEE LN
Practice Address - Street 2:
Practice Address - City:CORDOVA
Practice Address - State:TN
Practice Address - Zip Code:38018-4366
Practice Address - Country:US
Practice Address - Phone:310-977-6674
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-09
Last Update Date:2023-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT24660225100000X
TNPT0000007151225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist