Provider Demographics
NPI:1093061004
Name:MANUS, JERRY J
Entity Type:Individual
Prefix:
First Name:JERRY
Middle Name:J
Last Name:MANUS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1324 NE 23RD AVE
Mailing Address - Street 2:
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33909-1705
Mailing Address - Country:US
Mailing Address - Phone:239-772-9502
Mailing Address - Fax:
Practice Address - Street 1:6314 WHISKEY CREEK DR
Practice Address - Street 2:SUITE D
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33919-8762
Practice Address - Country:US
Practice Address - Phone:239-432-0556
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-27
Last Update Date:2012-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant