Active NPI
Mark Shahan Manalp, PTA
- Physical Therapy Assistant
- Jackson, MI
National Provider Identifier
1699060947
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapy Assistant
- License
- 5502002778
- Practice address
- 434 W North St
Jackson, MI 49202-3313 - Phone
- (517) 787-3250
- NPI assigned
- Jun 15, 2011
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapy Assistant | 225200000X | 5502002778 | MI | Primary |
Addresses
Primary practice location
434 W North St
Jackson, MI 49202-3313
Mailing address
217 W Allen St
Box 304
Hanover, MI 49241-8605
Phone (734) 218-6404
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5502002778 | MI | MD | Physical Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1308096000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1308096000000",
"number": "1699060947",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "217 W ALLEN ST",
"address_2": "BOX 304",
"city": "HANOVER",
"state": "MI",
"postal_code": "492418605",
"telephone_number": "734-218-6404"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "434 W NORTH ST",
"city": "JACKSON",
"state": "MI",
"postal_code": "492023313",
"telephone_number": "517-787-3250"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MANALP",
"first_name": "MARK",
"middle_name": "SHAHAN",
"credential": "PTA",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2011-06-15",
"last_updated": "2011-06-15",
"status": "A"
},
"taxonomies": [
{
"code": "225200000X",
"taxonomy_group": "",
"desc": "Physical Therapy Assistant",
"state": "MI",
"license": "5502002778",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Jackson, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 15, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.