MEDICARE: CAROL MCMANUS

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	225700000X	Massage Therapist	31469	CA

General Provider Information

NPI Number	:	1770973588
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAROL MCMANUS

Provider Business Mailing Address
First Line	:	457 PHLOX CT
Second Line	:
City	:	THOUSAND OAKS
State	:	CA
Zip	:	91360-1437
Country	:	US
Telephone Number	:	818-706-8719
Fax Number	:

Provider Business Practice Location Address
First Line	:	30423 CANWOOD ST
Second Line	:	#230
City	:	AGOURA HILLS
State	:	CA
Zip	:	91301-2082
Country	:	US
Telephone Number	:	818-706-8719
Fax Number	:

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

Provider Enumeration Date	:	02/01/2015
Last Update Date	:	02/01/2015

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Directions to “ CAROL MCMANUS ” Practice Location

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