Provider Demographics
NPI:1316754161
Name:MANNA THERAPEUTIC WELLNESS
Entity type:Organization
Organization Name:MANNA THERAPEUTIC WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:AARON
Authorized Official - Middle Name:
Authorized Official - Last Name:BALDWIN
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:930-204-9982
Mailing Address - Street 1:1312 WOODBINE LN
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47710-3872
Mailing Address - Country:US
Mailing Address - Phone:930-204-9982
Mailing Address - Fax:
Practice Address - Street 1:2568 WATERBRIDGE WAY # 2562
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47710-3200
Practice Address - Country:US
Practice Address - Phone:812-213-0184
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-16
Last Update Date:2024-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty