Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225100000X | Physical Therapist | 40QA00881200 | NJ |
N | 2251S0007X | Physical Therapist - Sports | 40QA00881200 | NJ |
N | 2251X0800X | Physical Therapist - Orthopedic | 40QA00881200 | NJ |
NPI | 1497827547 |
---|---|
Provider Name | Markus Lee Manley |
First Address | Bayville, NJ 08721-2345 |
Second Address | Toms River, NJ 08753-2900 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/11/2006 |
Last Update Date | 08/07/2007 |