Provider Demographics
NPI:1689866949
Name:MANUEL, HOWARD (PT)
Entity Type:Individual
Prefix:
First Name:HOWARD
Middle Name:
Last Name:MANUEL
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7501 W POTTAWATOMI DR
Mailing Address - Street 2:
Mailing Address - City:PALOS HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60463-2027
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:0 SOUTH 050 WINFIELD ROAD
Practice Address - Street 2:SUITE 120
Practice Address - City:WINFIELD
Practice Address - State:IL
Practice Address - Zip Code:60190
Practice Address - Country:US
Practice Address - Phone:630-653-4743
Practice Address - Fax:630-653-4912
Is Sole Proprietor?:No
Enumeration Date:2007-08-10
Last Update Date:2010-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070015087225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILK40484Medicare PIN
ILR03936Medicare PIN
ILR03935Medicare PIN