Provider Demographics
NPI:1063596393
Name:SARA J. MANWILLER, INC
Entity type:Organization
Organization Name:SARA J. MANWILLER, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:SARA
Authorized Official - Middle Name:JILL
Authorized Official - Last Name:MANWILLER
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:970-569-3883
Mailing Address - Street 1:PO BOX 4828
Mailing Address - Street 2:
Mailing Address - City:EDWARDS
Mailing Address - State:CO
Mailing Address - Zip Code:81632-4828
Mailing Address - Country:US
Mailing Address - Phone:970-569-3883
Mailing Address - Fax:970-569-3884
Practice Address - Street 1:1140 EDWARDS VILL BLVD
Practice Address - Street 2:B208
Practice Address - City:EDWARDS
Practice Address - State:CO
Practice Address - Zip Code:81632-4828
Practice Address - Country:US
Practice Address - Phone:970-569-3883
Practice Address - Fax:970-569-3884
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-24
Last Update Date:2020-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO474948Medicare ID - Type UnspecifiedGROUP NUMBER