Provider Demographics
NPI:1518559269
Name:MANZO, JOSE (PT, DPT)
Entity Type:Individual
Prefix:
First Name:JOSE
Middle Name:
Last Name:MANZO
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37 S MAIN ST STE C
Mailing Address - Street 2:
Mailing Address - City:WILLISTON
Mailing Address - State:FL
Mailing Address - Zip Code:32696-2681
Mailing Address - Country:US
Mailing Address - Phone:352-528-0022
Mailing Address - Fax:
Practice Address - Street 1:37 S MAIN ST STE C
Practice Address - Street 2:
Practice Address - City:WILLISTON
Practice Address - State:FL
Practice Address - Zip Code:32696-2681
Practice Address - Country:US
Practice Address - Phone:352-528-0022
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-04
Last Update Date:2021-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT36575225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist