Mana Performance Physical Therapy

Primary specialty

Physical Therapy Clinic/CenterTaxonomy code 261QP2000X

Legal business name

MANA PERFORMANCE PHYSICAL THERAPY

Practice address

80 Lyndon Rd
Fairport, NY 14450-9746

Phone

(585) 364-1586

Fax

(585) 310-0143

NPI assigned

Mar 23, 2022

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Russell John Manalastas, DPT, SCS, COMT, CSCSNPI 1366672685

Title

Owner

Phone

(443) 540-8419

Specialties & licenses 2

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Russell John Manalastas, DPT, CSCS

  • Physical Therapist
  • Spencerport, NY
  • NPI 1366672685
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1647993600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1648425600000",
    "number": "1093464158",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "80 LYNDON RD",
            "city": "FAIRPORT",
            "state": "NY",
            "postal_code": "144509746",
            "telephone_number": "585-364-1586",
            "fax_number": "585-310-0143"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "80 LYNDON RD",
            "city": "FAIRPORT",
            "state": "NY",
            "postal_code": "144509746",
            "telephone_number": "585-364-1586",
            "fax_number": "585-310-0143"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MANA PERFORMANCE PHYSICAL THERAPY",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-03-23",
        "last_updated": "2022-03-28",
        "certification_date": "2022-03-28",
        "status": "A",
        "authorized_official_last_name": "MANALASTAS",
        "authorized_official_first_name": "RUSSELL",
        "authorized_official_middle_name": "JOHN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "443-540-8419",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "DPT, SCS, COMT, CSCS"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Therapy Assistant",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Caroline Ilona Magyar, PH.D.
• Joseph Francis Maier
• Megan Maley
• Everien Rebecca Malone, SLP
• Amie Maloney, MS ED
• Nancy Mancini
• Ashley E Mancuso
• Theresa Mancuso, OCCUPATIONAL THERAPI
• Laura Ann Mangerian-Smith, RN
• Lea Rose Manilla, L.AC., DIPL. O.M.

• Physical Therapy Clinic/Center in Fairport, NY
• Providers in Fairport, NY by specialty
• Physical Therapy Clinic/Center in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 28, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.