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General NPI Number Information
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NPI Number | 1811513278
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Entity Type | Organization
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Legal Business Name | MANIGAULT ENTERPRISE, L.L.C.
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Dates
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Enumeration Date | 06/22/2020
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Last Update Date | 10/17/2023
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Provider Practice Location Address
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Address Line | 2103 WOODTOP WAY
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City | BEL AIR
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State | MD
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Zip | 21015-6370
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Country | US
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Telephone | 410-905-8150
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Fax |
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Provider Business Mailing Address
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Address Line | 2103 WOODTOP WAY
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City | BEL AIR
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State | MD
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Zip | 21015-6370
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Country | US
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Telephone | 410-905-8150
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Fax |
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Authorized Official
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Title or Position | CEO,PARTNER/OPERATIONS MANAGER
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Name | MRS. SAMANTHA MARIE MANIGAULT
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Credential | MS, BS
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Telephone | 410-905-8150
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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 #2
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Taxonomy Code | 261QI0500X
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Taxonomy Name | Infusion Therapy Clinic/Center
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License Number |
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License Number State |
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