Provider Demographics
NPI:1689948325
Name:JOSEPH, MANU (PT)
Entity Type:Individual
Prefix:
First Name:MANU
Middle Name:
Last Name:JOSEPH
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:258 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:GALLATIN
Mailing Address - State:TN
Mailing Address - Zip Code:37066-2961
Mailing Address - Country:US
Mailing Address - Phone:615-452-9686
Mailing Address - Fax:615-452-9652
Practice Address - Street 1:258 E MAIN ST
Practice Address - Street 2:
Practice Address - City:GALLATIN
Practice Address - State:TN
Practice Address - Zip Code:37066-2961
Practice Address - Country:US
Practice Address - Phone:615-452-9686
Practice Address - Fax:615-452-9652
Is Sole Proprietor?:No
Enumeration Date:2012-02-27
Last Update Date:2012-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501014173225100000X
TN8252225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist