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General NPI Number Information
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NPI Number | 1396222832
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Entity Type | Individual
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Provider Name | NICHOLAS JAMES MANNING DPT
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Gender | Male
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Dates
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Enumeration Date | 07/27/2018
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Last Update Date | 11/01/2021
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Provider Practice Location Address
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Address Line | 299 COON RAPIDS BLVD NW STE 103
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City | COON RAPIDS
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State | MN
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Zip | 55433-5869
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Country | US
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Telephone | 612-217-2154
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Fax | 612-447-0159
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Provider Business Mailing Address
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Address Line | 299 COON RAPIDS BLVD NW STE 103
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City | COON RAPIDS
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State | MN
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Zip | 55433-5869
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Country | US
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Telephone | 612-217-2154
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Fax | 612-447-0159
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2251X0800X
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Taxonomy Name | Orthopedic Physical Therapist
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License Number | 10307
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License Number State | MN
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 10307
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License Number State | MN
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