Healthcare Provider Details

I. General information

NPI: 1326155250
Provider Name (Legal Business Name): MANNON MOTION, LTD. CO.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/24/2006
Last Update Date: 10/05/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

106 WARM SPRINGS BLVD
ELEPHANT BUTTE NM
87935
US

IV. Provider business mailing address

PO BOX 492
ELEPHANT BUTTE NM
87935-0492
US

V. Phone/Fax

Practice location:
  • Phone: 505-744-5187
  • Fax: 505-744-4911
Mailing address:
  • Phone: 505-744-5187
  • Fax: 505-744-4911

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number#2194
License Number StateNM

VIII. Authorized Official

Name: MS. KORI R MANNON
Title or Position: OWNER
Credential: MPT
Phone: 505-744-5187