MEDICARE: MICHAEL J MANNERAAK PT, MRS-PT

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	4126	SC

General Provider Information

NPI Number	:	1356538102
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL J MANNERAAK PT, MRS-PT

Provider Business Mailing Address
First Line	:	2125 CHARLIE HALL BLVD
Second Line	:
City	:	CHARLESTON
State	:	SC
Zip	:	29414-5879
Country	:	US
Telephone Number	:	843-573-1513
Fax Number	:	843-573-1511

Provider Business Practice Location Address
First Line	:	2125 CHARLIE HALL BLVD
Second Line	:
City	:	CHARLESTON
State	:	SC
Zip	:	29414-5879
Country	:	US
Telephone Number	:	843-573-1513
Fax Number	:	843-573-1511

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

Provider Enumeration Date	:	09/26/2007
Last Update Date	:	09/26/2007

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