Provider Demographics
NPI:1760406078
Name:MANNERS, JILL ANN (LAT, ATC, PT, NREMT)
Entity type:Individual
Prefix:DR
First Name:JILL
Middle Name:ANN
Last Name:MANNERS
Suffix:
Gender:F
Credentials:LAT, ATC, PT, NREMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:TEXAS TECH UNIVERSITY HEALTH SCIENCES CENTER
Mailing Address - Street 2:3601 4TH ST., STOP 6226
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79430
Mailing Address - Country:US
Mailing Address - Phone:806-743-2793
Mailing Address - Fax:
Practice Address - Street 1:TEXAS TECH UNIVERSITY HEALTH SCIENCES CENTER
Practice Address - Street 2:3601 4TH ST., STOP 6226
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79430
Practice Address - Country:US
Practice Address - Phone:806-743-2793
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2025-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX794219146N00000X
E3881703146N00000X
GAPT013778225100000X
PART0069392255A2300X
TXAT100202255A2300X
GAAT0016162255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
No146N00000XEmergency Medical Service ProvidersEmergency Medical Technician, Basic
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist