Provider Demographics
NPI:1063736627
Name:MANN, GEORGE STEPHEN III (PT)
Entity type:Individual
Prefix:MR
First Name:GEORGE
Middle Name:STEPHEN
Last Name:MANN
Suffix:III
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 1:4685 COUNTY ROAD Y
Mailing Address - Street 2:
Mailing Address - City:SAUKVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:53080-1117
Mailing Address - Country:US
Mailing Address - Phone:262-689-8185
Mailing Address - Fax:
Practice Address - Street 1:4685 COUNTY ROAD Y
Practice Address - Street 2:
Practice Address - City:SAUKVILLE
Practice Address - State:WI
Practice Address - Zip Code:53080-1117
Practice Address - Country:US
Practice Address - Phone:262-689-8185
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-03-25
Last Update Date:2010-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1516-024225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist