Provider Demographics
NPI:1477197747
Name:MANUAL THERAPY SPECIALISTS
Entity Type:Organization
Organization Name:MANUAL THERAPY SPECIALISTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/FOUNDER
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:J
Authorized Official - Last Name:POTUCEK
Authorized Official - Suffix:
Authorized Official - Credentials:MSPT CFMT
Authorized Official - Phone:203-557-9111
Mailing Address - Street 1:1300 POST RD STE 210
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06824-6038
Mailing Address - Country:US
Mailing Address - Phone:203-557-9111
Mailing Address - Fax:203-601-7110
Practice Address - Street 1:1300 POST RD STE 210
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:CT
Practice Address - Zip Code:06824-6038
Practice Address - Country:US
Practice Address - Phone:203-557-9111
Practice Address - Fax:203-601-7110
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-30
Last Update Date:2020-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy