Healthcare Provider Details

I. General information

NPI: 1336101872
Provider Name (Legal Business Name): SUSAN EVELYN MANLEY PT
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 04/03/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

108 RIDGE ROAD STE D
NORTH ARLINGTON NJ
07031
US

IV. Provider business mailing address

105 HEDDEN TERRACE
NORTH ARLINGTON NJ
07031
US

V. Phone/Fax

Practice location:
  • Phone: 201-997-3234
  • Fax: 201-997-3417
Mailing address:
  • Phone: 201-991-7564
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number40QA00478900
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: