MEDICARE: MR. EDWARD M MANN MSPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	5501009027	MI

General Provider Information

NPI Number	:	1265491666
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. EDWARD M MANN MSPT

Provider Business Mailing Address
First Line	:	21450 CANTERBURY
Second Line	:
City	:	GROSSE ILE
State	:	MI
Zip	:	48138
Country	:	US
Telephone Number	:	734-675-4629
Fax Number	:

Provider Business Practice Location Address
First Line	:	14700 KING RD STE B
Second Line	:
City	:	RIVERVIEW
State	:	MI
Zip	:	48193-7909
Country	:	US
Telephone Number	:	734-288-0235
Fax Number	:	734-288-0236

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/23/2006
Last Update Date	:	06/14/2023

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Directions to “ MR. EDWARD M MANN MSPT” Practice Location

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