MEDICARE: SARA J. MANWILLER, INC

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

General Provider Information

NPI Number	:	1063596393
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SARA J. MANWILLER, INC

Provider Business Mailing Address
First Line	:	PO BOX 4828
Second Line	:
City	:	EDWARDS
State	:	CO
Zip	:	81632-4828
Country	:	US
Telephone Number	:	970-569-3883
Fax Number	:	970-569-3884

Provider Business Practice Location Address
First Line	:	1140 EDWARDS VILL BLVD
Second Line	:	B208
City	:	EDWARDS
State	:	CO
Zip	:	81632-4828
Country	:	US
Telephone Number	:	970-569-3883
Fax Number	:	970-569-3884

Authorized Official
Title or Position	:	OWNER
Name	:	MS. SARA JILL MANWILLER
Credential	:	PT
Telephone Number	:	970-569-3883

Provider Enumeration Date	:	10/24/2006
Last Update Date	:	07/21/2020

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