Provider Demographics
NPI:1619726262
Name:MANNING PHYSICAL THERAPY
Entity type:Organization
Organization Name:MANNING PHYSICAL THERAPY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICAL THERAPY
Authorized Official - Prefix:
Authorized Official - First Name:MYCHAL
Authorized Official - Middle Name:
Authorized Official - Last Name:MANNING
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:541-209-6729
Mailing Address - Street 1:20460 DEL COCO CT
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97702-9414
Mailing Address - Country:US
Mailing Address - Phone:949-290-5193
Mailing Address - Fax:541-605-3286
Practice Address - Street 1:1725 SW CHANDLER AVE STE 102
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97702-3249
Practice Address - Country:US
Practice Address - Phone:541-209-6729
Practice Address - Fax:541-605-3286
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-16
Last Update Date:2024-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty