Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251X0800X | Physical Therapist - Orthopedic | 1255819 | TX |
NPI | 1023402146 |
---|---|
Provider Name | Seth Manly |
First Address | Irving, TX 75038-5917 |
Second Address | Irving, TX 75061-2256 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/03/2015 |
Last Update Date | 26/03/2015 |