Provider Demographics
NPI:1477584555
Name:MANHATTAN THERAPIES, INC
Entity Type:Organization
Organization Name:MANHATTAN THERAPIES, INC
Other - Org Name:BODY DYNAMICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SEC./TREAS
Authorized Official - Prefix:
Authorized Official - First Name:DEBBIE
Authorized Official - Middle Name:A
Authorized Official - Last Name:MAKAENA
Authorized Official - Suffix:
Authorized Official - Credentials:PTA
Authorized Official - Phone:310-643-9016
Mailing Address - Street 1:2250 PARK PL
Mailing Address - Street 2:
Mailing Address - City:EL SEGUNDO
Mailing Address - State:CA
Mailing Address - Zip Code:90245-4908
Mailing Address - Country:US
Mailing Address - Phone:310-643-9016
Mailing Address - Fax:310-536-0177
Practice Address - Street 1:2250 PARK PL
Practice Address - Street 2:
Practice Address - City:EL SEGUNDO
Practice Address - State:CA
Practice Address - Zip Code:90245-4908
Practice Address - Country:US
Practice Address - Phone:310-643-9016
Practice Address - Fax:310-536-0177
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-06
Last Update Date:2008-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC10108171100000X
CAPT14137225100000X
CAOT7320225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
No171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW22258Medicare PIN