Organization
MANUAL EDGE PHYSICAL THERAPY SPECIALISTS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TIMOTHY D BONACK (CEO/OWNER)
(719) 694-8342
Entity
Organization
Contact information
Practice address
1840 WOODMOOR DR STE 106, MONUMENT, CO 80132-9098
(719) 694-9747
(719) 694-9832
Mailing address
1840 WOODMOOR DR STE 106, MONUMENT, CO 80132-9098
(719) 694-9747
(719) 694-9832
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
PENDING
—
CO
Enumeration date
11/26/2024
Last updated
11/26/2024
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