Provider Demographics
NPI:1295432326
Name:MANN, JOHN W (PT)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:W
Last Name:MANN
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:6480 HARRISON AVE STE 201
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45247-7961
Mailing Address - Country:US
Mailing Address - Phone:513-354-7785
Mailing Address - Fax:513-354-7651
Practice Address - Street 1:810 FALLS CREEK DR
Practice Address - Street 2:
Practice Address - City:VANDALIA
Practice Address - State:OH
Practice Address - Zip Code:45377-8600
Practice Address - Country:US
Practice Address - Phone:937-298-2584
Practice Address - Fax:937-298-0894
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-09
Last Update Date:2023-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT010240225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0011459Medicaid