Provider Demographics
NPI:1962963280
Name:MANUAL MEDICINE SPINE AND SPORTS PHYSICAL THERAPY
Entity type:Organization
Organization Name:MANUAL MEDICINE SPINE AND SPORTS PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REPRESENTATIVE
Authorized Official - Prefix:MS
Authorized Official - First Name:TRUPTI
Authorized Official - Middle Name:BIPINCHANDRA
Authorized Official - Last Name:MEHTA
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:919-302-5091
Mailing Address - Street 1:833 DECATUR ST NW
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20011
Mailing Address - Country:US
Mailing Address - Phone:202-670-8874
Mailing Address - Fax:
Practice Address - Street 1:1015 15TH ST NW, STE 614K
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20005
Practice Address - Country:US
Practice Address - Phone:202-670-8874
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-28
Last Update Date:2019-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy