MEDICARE: KUMAR MANAM PT,PHD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	5501011016	MI

General Provider Information

NPI Number	:	1023157989
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KUMAR MANAM PT,PHD

Provider Business Mailing Address
First Line	:	8327 OXFORD LN
Second Line	:
City	:	GRAND BLANC
State	:	MI
Zip	:	48439-7449
Country	:	US
Telephone Number	:	810-695-8689
Fax Number	:

Provider Business Practice Location Address
First Line	:	8327 OXFORD LN
Second Line	:
City	:	GRAND BLANC
State	:	MI
Zip	:	48439-7449
Country	:	US
Telephone Number	:	810-695-8689
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/06/2007
Last Update Date	:	11/07/2007

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