Provider Demographics
NPI:1609542109
Name:MANUAL EDGE PHYSICAL THERAPY SPECIALISTS LLC
Entity Type:Organization
Organization Name:MANUAL EDGE PHYSICAL THERAPY SPECIALISTS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:
Authorized Official - Last Name:BONAK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:719-694-8342
Mailing Address - Street 1:6189 LEHMAN DR STE 202
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80918-5409
Mailing Address - Country:US
Mailing Address - Phone:719-694-8342
Mailing Address - Fax:719-694-8347
Practice Address - Street 1:6189 LEHMAN DR STE 202
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80918-5409
Practice Address - Country:US
Practice Address - Phone:719-694-8342
Practice Address - Fax:719-694-8347
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-17
Last Update Date:2021-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Single Specialty