1346206497 NPI number — MRS. SHERRY MOLINAR MANZELLI MS, LAT, ATC

Table of content: MRS. SHERRY MOLINAR MANZELLI MS, LAT, ATC (NPI 1346206497)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1346206497 NPI number — MRS. SHERRY MOLINAR MANZELLI MS, LAT, ATC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MANZELLI
Provider First Name:
SHERRY
Provider Middle Name:
MOLINAR
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MS, LAT, ATC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1346206497
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2555 PARR DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
INDIANAPOLIS
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46220-1325
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
317-253-5655
Provider Business Mailing Address Fax Number:
317-415-5748

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8227 NORTHWEST BLVD
Provider Second Line Business Practice Location Address:
STE. 160
Provider Business Practice Location Address City Name:
INDIANAPOLIS
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46278-1387
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
317-425-5747
Provider Business Practice Location Address Fax Number:
317-415-5748
Provider Enumeration Date:
04/25/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2255A2300X , with the licence number:  36000432A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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