Provider Demographics
NPI:1003006255
Name:MANUAL THERAPY ASSOCIATES
Entity Type:Organization
Organization Name:MANUAL THERAPY ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KATHERINE
Authorized Official - Middle Name:A
Authorized Official - Last Name:BEHRENS
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:317-817-9930
Mailing Address - Street 1:13431 OLD MERIDIAN ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46032-7101
Mailing Address - Country:US
Mailing Address - Phone:317-817-9930
Mailing Address - Fax:317-375-7908
Practice Address - Street 1:13431 OLD MERIDIAN ST
Practice Address - Street 2:SUITE 100
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46032-7101
Practice Address - Country:US
Practice Address - Phone:317-817-9930
Practice Address - Fax:317-375-7908
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-25
Last Update Date:2007-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05005408A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN7197300OtherAETNA
IN210610Medicare PIN