Provider Demographics
NPI:1497827547
Name:MANLEY, MARKUS LEE (MPT)
Entity Type:Individual
Prefix:
First Name:MARKUS
Middle Name:LEE
Last Name:MANLEY
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:MARK
Other - Middle Name:LEE
Other - Last Name:MANLEY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MPT
Mailing Address - Street 1:395 PRINCETON AVE
Mailing Address - Street 2:
Mailing Address - City:BAYVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08721-2345
Mailing Address - Country:US
Mailing Address - Phone:732-269-4436
Mailing Address - Fax:732-341-9004
Practice Address - Street 1:40 BEY LEA RD
Practice Address - Street 2:BUILDING C, SUITE 101
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08753-2900
Practice Address - Country:US
Practice Address - Phone:732-341-9901
Practice Address - Fax:732-341-9004
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00881200225100000X, 2251S0007X, 2251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Not Answered2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSports
Not Answered2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic