Basic Information
| Provider Information | |||||||||
| NPI: | 1275512139 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MANYAK | ||||||||
| FirstName: | CHRISTINE | ||||||||
| MiddleName: | M | ||||||||
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| Credential: | PT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5 NEPONSET ST FL ST2 | ||||||||
| Address2: | |||||||||
| City: | WORCESTER | ||||||||
| State: | MA | ||||||||
| PostalCode: | 016062714 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5083685532 | ||||||||
| FaxNumber: | 5087211102 | ||||||||
| Practice Location | |||||||||
| Address1: | 385 SOUTHBRIDGE ST | ||||||||
| Address2: | |||||||||
| City: | AUBURN | ||||||||
| State: | MA | ||||||||
| PostalCode: | 015012498 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5087211101 | ||||||||
| FaxNumber: | 5087211102 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/10/2006 | ||||||||
| LastUpdateDate: | 03/25/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 7467 | MA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | 7038566 | 01 | AETNA US HEALTHCARE | OTHER | 785958 | 01 | MVP HEALTH CARE | OTHER | 43208 | 01 | FALLON COMMUNITY HEALTH | OTHER | A052A | 01 | HARVARD PILGRIM HEALTHCAR | OTHER | Y68460 | 01 | MEDICARE B | OTHER | 2779432 | 01 | CIGNA HEALTH PLAN | OTHER | 042472266 | 01 | HEALTHCARE VALUE MANAGEME | OTHER | 042472266 | 01 | PRIVATE HEALTHCARE SYSTEM | OTHER | 042472266 | 01 | THREE RIVERS | OTHER | 0318957 | 05 | MA | MEDICAID | Y67940 | 01 | BLUE SHIELD HMO BLUE | OTHER | Y67940 | 01 | BLUE SHIELD INDEMNITY | OTHER | 042472266 | 01 | ONE HEALTH PLAN | OTHER | 2779432001 | 01 | CIGNA PAL ID | OTHER | Y67940 | 01 | BLUE CARE ELECT | OTHER | 0318957 | 01 | MEDICAID WELFARE | OTHER | 35481155 | 01 | CIGNA HEALTHSOURCE | OTHER | 45959 | 01 | CHILDRENS MEDICAL SECURIT | OTHER | 650017413 | 01 | RAILROAD MEDICARE | OTHER |