Provider Demographics
NPI:1396222832
Name:MANNING, NICHOLAS JAMES (DPT)
Entity Type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:JAMES
Last Name:MANNING
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:299 COON RAPIDS BLVD NW STE 103
Mailing Address - Street 2:
Mailing Address - City:COON RAPIDS
Mailing Address - State:MN
Mailing Address - Zip Code:55433-5869
Mailing Address - Country:US
Mailing Address - Phone:612-217-2154
Mailing Address - Fax:612-447-0159
Practice Address - Street 1:299 COON RAPIDS BLVD NW STE 103
Practice Address - Street 2:
Practice Address - City:COON RAPIDS
Practice Address - State:MN
Practice Address - Zip Code:55433-5869
Practice Address - Country:US
Practice Address - Phone:612-217-2154
Practice Address - Fax:612-447-0159
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-27
Last Update Date:2021-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN103072251X0800X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic