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General NPI Number Information
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NPI Number | 1376149393
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Entity Type | Organization
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Legal Business Name | ANODYNE OF MANCHESTER, LLC
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Dates
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Enumeration Date | 12/06/2020
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Last Update Date | 04/18/2022
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Provider Practice Location Address
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Address Line | 1001 BRITTANY PKWY
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City | MANCHESTER
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State | MO
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Zip | 63011-4325
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Country | US
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Telephone | 636-330-7246
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Fax |
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Provider Business Mailing Address
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Address Line | 1001 BRITTANY PKWY
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City | MANCHESTER
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State | MO
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Zip | 63011-4325
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Country | US
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Telephone | 636-330-7246
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | JONATHAN POLLOCK
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Credential |
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Telephone | 636-330-7246
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number |
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License Number State |
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