Provider Demographics
NPI:1558845602
Name:MANZANO, CHRISTOPHER WAYNE (PT, DPT, ATC, CSCS)
Entity Type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:WAYNE
Last Name:MANZANO
Suffix:
Gender:M
Credentials:PT, DPT, ATC, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:376 BOYLSTON ST STE 201
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02116-3828
Mailing Address - Country:US
Mailing Address - Phone:617-275-6022
Mailing Address - Fax:
Practice Address - Street 1:1 CONSTITUTION WHARF
Practice Address - Street 2:SUITE 140
Practice Address - City:CHARLESTOWN
Practice Address - State:MA
Practice Address - Zip Code:02129
Practice Address - Country:US
Practice Address - Phone:857-972-4256
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-24
Last Update Date:2024-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA30512255A2300X
MA27376225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer