Provider Demographics
NPI:1831228832
Name:MANLEY, MICHAEL DIRK (PT)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:DIRK
Last Name:MANLEY
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:5931 STANLEY AVE
Mailing Address - Street 2:SUITE 5
Mailing Address - City:CARMICHAEL
Mailing Address - State:CA
Mailing Address - Zip Code:95608-3846
Mailing Address - Country:US
Mailing Address - Phone:916-481-8238
Mailing Address - Fax:916-481-8239
Practice Address - Street 1:5931 STANLEY AVE
Practice Address - Street 2:SUITE 5
Practice Address - City:CARMICHAEL
Practice Address - State:CA
Practice Address - Zip Code:95608-3846
Practice Address - Country:US
Practice Address - Phone:916-481-8238
Practice Address - Fax:916-481-8239
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-05
Last Update Date:2015-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA0PT249471225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1831228832Medicare PIN