Healthcare Provider Details

I. General information

NPI: 1740822840
Provider Name (Legal Business Name): MANES FOR MOVEMENT, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/10/2019
Last Update Date: 10/10/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 WILDHORSE LN
ROLLING HILLS ESTATES CA
90274-1528
US

IV. Provider business mailing address

PO BOX 1587
TORRANCE CA
90505-0587
US

V. Phone/Fax

Practice location:
  • Phone: 310-737-2938
  • Fax:
Mailing address:
  • Phone: 310-737-2938
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ERIN O'MAHONY
Title or Position: CHIEF EXECUTIVE OFFICER
Credential: PT, DPT
Phone: 310-737-2938