Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225100000X | Physical Therapist | 22818 | MD |
Y | 2251X0800X | Physical Therapist - Orthopedic | 301136 | CA |
NPI | 1073751145 |
---|---|
Provider Name | Matthew Robert Manzi |
First Address | Swan Lake, NY 12783-5809 |
Second Address | Salinas, CA 93905-3803 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/01/2009 |
Last Update Date | 18/11/2021 |