Provider Demographics
NPI:1235422361
Name:CORA MANUEL THERAPY SERVICES, LLC
Entity Type:Organization
Organization Name:CORA MANUEL THERAPY SERVICES, LLC
Other - Org Name:ACTIVE PHYSICAL REHAB
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BUSINESS OWNER/PHYSICAL THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:CORA
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:MANUEL
Authorized Official - Suffix:
Authorized Official - Credentials:PT, MPT
Authorized Official - Phone:337-831-8001
Mailing Address - Street 1:PO BOX 185
Mailing Address - Street 2:
Mailing Address - City:REDDELL
Mailing Address - State:LA
Mailing Address - Zip Code:70580-0185
Mailing Address - Country:US
Mailing Address - Phone:337-831-8001
Mailing Address - Fax:
Practice Address - Street 1:1605 7TH ST STE B
Practice Address - Street 2:
Practice Address - City:MAMOU
Practice Address - State:LA
Practice Address - Zip Code:70554-2221
Practice Address - Country:US
Practice Address - Phone:337-468-4685
Practice Address - Fax:337-468-4692
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-23
Last Update Date:2011-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA06432261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy