Provider Demographics
NPI:1043252836
Name:MCMANUS, GREG DAVID (PT, ATC)
Entity Type:Individual
Prefix:MR
First Name:GREG
Middle Name:DAVID
Last Name:MCMANUS
Suffix:
Gender:M
Credentials:PT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4104 ABBEY RD
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:NM
Mailing Address - Zip Code:87402-5151
Mailing Address - Country:US
Mailing Address - Phone:505-716-8747
Mailing Address - Fax:
Practice Address - Street 1:511 E 20TH ST
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:NM
Practice Address - Zip Code:87401-2105
Practice Address - Country:US
Practice Address - Phone:505-326-0064
Practice Address - Fax:505-327-3995
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM2823225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist