Provider Demographics
NPI:1023402146
Name:MANLY, SETH (DPT)
Entity Type:Individual
Prefix:
First Name:SETH
Middle Name:
Last Name:MANLY
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3956 N STORY RD APT 534
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75038-5917
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2001 N MACARTHUR BLVD
Practice Address - Street 2:SUITE 550
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75061-2256
Practice Address - Country:US
Practice Address - Phone:972-579-4398
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-26
Last Update Date:2015-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12558192251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic