Provider Demographics
NPI:1124072384
Name:MANUAL THERAPY ASSOCIATES LLC
Entity type:Organization
Organization Name:MANUAL THERAPY ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:AMY
Authorized Official - Middle Name:M
Authorized Official - Last Name:HOLCOMBE
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:704-716-1024
Mailing Address - Street 1:10009 PARK CEDAR DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28210-8920
Mailing Address - Country:US
Mailing Address - Phone:704-716-1024
Mailing Address - Fax:704-716-1025
Practice Address - Street 1:10009 PARK CEDAR DR
Practice Address - Street 2:SUITE 100
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28210-8920
Practice Address - Country:US
Practice Address - Phone:704-716-1024
Practice Address - Fax:704-716-1025
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-20
Last Update Date:2013-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7211761Medicaid
NC7211761Medicaid