Organization
MANA PERFORMANCE PHYSICAL THERAPY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. RUSSELL JOHN MANALASTAS DPT, SCS, COMT, CSCS (OWNER)
(443) 540-8419
Entity
Organization
Contact information
Practice address
80 LYNDON RD, FAIRPORT, NY 14450-9746
(585) 364-1586
(585) 310-0143
Mailing address
80 LYNDON RD, FAIRPORT, NY 14450-9746
(585) 364-1586
(585) 310-0143
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
—
—
261QP2000X
Physical Therapy Clinic/Center
Primary
—
—
Other
Enumeration date
03/23/2022
Last updated
03/28/2022
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