Provider Demographics
NPI:1013221894
Name:WOMENS MANUAL PHYSICAL THERAPY LLC
Entity Type:Organization
Organization Name:WOMENS MANUAL PHYSICAL THERAPY LLC
Other - Org Name:FYZICAL THERAPY AND BALANCE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EVP/CFO
Authorized Official - Prefix:
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:941-870-7090
Mailing Address - Street 1:9070 W CHEYENNE AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89129-8935
Mailing Address - Country:US
Mailing Address - Phone:702-818-5000
Mailing Address - Fax:702-818-5001
Practice Address - Street 1:728 N FERDON BLVD
Practice Address - Street 2:STE #3
Practice Address - City:CRESTVIEW
Practice Address - State:FL
Practice Address - Zip Code:32536-2166
Practice Address - Country:US
Practice Address - Phone:850-682-7772
Practice Address - Fax:888-308-1539
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-03
Last Update Date:2024-02-19
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
AL592-14101OtherBCBS OF ALABAMA
FLY90JWOtherBCBS
AL592-14103OtherBCBS OF ALABAMA
FLY90JWOtherBCBS