Provider Demographics
NPI:1215949334
Name:MCMANUS, MATTHEW R (PT)
Entity type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:R
Last Name:MCMANUS
Suffix:
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 1:7 MAPLE TER
Mailing Address - Street 2:
Mailing Address - City:NEWBURY
Mailing Address - State:MA
Mailing Address - Zip Code:01951-1108
Mailing Address - Country:US
Mailing Address - Phone:781-935-2655
Mailing Address - Fax:
Practice Address - Street 1:1 ARROW DR
Practice Address - Street 2:SUITE 2
Practice Address - City:WOBURN
Practice Address - State:MA
Practice Address - Zip Code:01801-2039
Practice Address - Country:US
Practice Address - Phone:781-935-2655
Practice Address - Fax:781-935-9097
Is Sole Proprietor?:No
Enumeration Date:2006-08-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA13166174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAY68109Medicare ID - Type Unspecified