Provider Demographics
NPI:1477727196
Name:FUNCTIONAL MANUAL THERAPY LLC
Entity Type:Organization
Organization Name:FUNCTIONAL MANUAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:R
Authorized Official - Last Name:WEISMANTEL
Authorized Official - Suffix:
Authorized Official - Credentials:PHYSICAL THERAPIST
Authorized Official - Phone:717-632-3734
Mailing Address - Street 1:961 FUHRMAN MILL RD
Mailing Address - Street 2:
Mailing Address - City:HANOVER
Mailing Address - State:PA
Mailing Address - Zip Code:17331-9515
Mailing Address - Country:US
Mailing Address - Phone:717-632-3734
Mailing Address - Fax:717-632-3734
Practice Address - Street 1:961 FUHRMAN MILL RD
Practice Address - Street 2:
Practice Address - City:HANOVER
Practice Address - State:PA
Practice Address - Zip Code:17331-9515
Practice Address - Country:US
Practice Address - Phone:717-632-3734
Practice Address - Fax:717-632-3734
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-14
Last Update Date:2009-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADAPT000373174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty