Provider Demographics
NPI:1265491666
Name:MANN, EDWARD M (MSPT)
Entity Type:Individual
Prefix:MR
First Name:EDWARD
Middle Name:M
Last Name:MANN
Suffix:
Gender:M
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21450 CANTERBURY
Mailing Address - Street 2:
Mailing Address - City:GROSSE ILE
Mailing Address - State:MI
Mailing Address - Zip Code:48138
Mailing Address - Country:US
Mailing Address - Phone:734-675-4629
Mailing Address - Fax:
Practice Address - Street 1:14700 KING RD STE B
Practice Address - Street 2:
Practice Address - City:RIVERVIEW
Practice Address - State:MI
Practice Address - Zip Code:48193-7909
Practice Address - Country:US
Practice Address - Phone:734-288-0235
Practice Address - Fax:734-288-0236
Is Sole Proprietor?:No
Enumeration Date:2006-03-23
Last Update Date:2023-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501009027225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist