Healthcare Provider Details

I. General information

NPI: 1477584555
Provider Name (Legal Business Name): MANHATTAN THERAPIES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/06/2006
Last Update Date: 07/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2250 PARK PL
EL SEGUNDO CA
90245-4908
US

IV. Provider business mailing address

2250 PARK PL
EL SEGUNDO CA
90245-4908
US

V. Phone/Fax

Practice location:
  • Phone: 310-643-9016
  • Fax: 310-536-0177
Mailing address:
  • Phone: 310-643-9016
  • Fax: 310-536-0177

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC10108
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT7320
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT14137
License Number StateCA

VIII. Authorized Official

Name: DEBBIE A MAKAENA
Title or Position: SEC./TREAS
Credential: PTA
Phone: 310-643-9016