Healthcare Provider Details

I. General information

NPI: 1376467951
Provider Name (Legal Business Name): OLIVIA MANUEL PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/06/2026
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5675 26TH AVE S STE 152
FARGO ND
58104-8975
US

IV. Provider business mailing address

5675 26TH AVE S STE 152
FARGO ND
58104-8975
US

V. Phone/Fax

Practice location:
  • Phone: 701-532-2270
  • Fax: 701-532-0507
Mailing address:
  • Phone: 701-532-2270
  • Fax: 701-532-0507

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2941
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: