Provider Demographics
NPI:1326155250
Name:MANNON MOTION, LTD. CO.
Entity Type:Organization
Organization Name:MANNON MOTION, LTD. CO.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:KORI
Authorized Official - Middle Name:R
Authorized Official - Last Name:MANNON
Authorized Official - Suffix:
Authorized Official - Credentials:MPT
Authorized Official - Phone:505-744-5187
Mailing Address - Street 1:PO BOX 492
Mailing Address - Street 2:
Mailing Address - City:ELEPHANT BUTTE
Mailing Address - State:NM
Mailing Address - Zip Code:87935-0492
Mailing Address - Country:US
Mailing Address - Phone:505-744-5187
Mailing Address - Fax:505-744-4911
Practice Address - Street 1:106 WARM SPRINGS BLVD
Practice Address - Street 2:
Practice Address - City:ELEPHANT BUTTE
Practice Address - State:NM
Practice Address - Zip Code:87935
Practice Address - Country:US
Practice Address - Phone:505-744-5187
Practice Address - Fax:505-744-4911
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-24
Last Update Date:2007-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM#2194261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM43683291Medicaid