Provider Demographics
NPI:1659319358
Name:MANUAL THERAPY ASSOCIATES, INC
Entity Type:Organization
Organization Name:MANUAL THERAPY ASSOCIATES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:A
Authorized Official - Last Name:DO
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:303-456-2671
Mailing Address - Street 1:12001 W 63RD PL
Mailing Address - Street 2:SUITE 5
Mailing Address - City:ARVADA
Mailing Address - State:CO
Mailing Address - Zip Code:80004-4034
Mailing Address - Country:US
Mailing Address - Phone:303-456-2671
Mailing Address - Fax:303-456-0220
Practice Address - Street 1:12001 W 63RD PL
Practice Address - Street 2:SUITE 5
Practice Address - City:ARVADA
Practice Address - State:CO
Practice Address - Zip Code:80004-4034
Practice Address - Country:US
Practice Address - Phone:303-456-2671
Practice Address - Fax:303-456-0220
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-03
Last Update Date:2008-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO3217261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
COC476218Medicare PIN