Provider Demographics
NPI:1689957490
Name:MANUS PHYSICAL THERAPY, INC
Entity Type:Organization
Organization Name:MANUS PHYSICAL THERAPY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DIANA
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON-FORD
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:561-288-8810
Mailing Address - Street 1:900 E INDIANTOWN RD
Mailing Address - Street 2:SUITE 111
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33477-5165
Mailing Address - Country:US
Mailing Address - Phone:561-288-8810
Mailing Address - Fax:877-464-1813
Practice Address - Street 1:900 E INDIANTOWN RD
Practice Address - Street 2:SUITE 111
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33477-5165
Practice Address - Country:US
Practice Address - Phone:561-288-8810
Practice Address - Fax:877-464-1813
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-28
Last Update Date:2012-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL8829261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy