Provider Demographics
NPI:1124630850
Name:KEVIN CARL MANABE CORIANO
Entity type:Organization
Organization Name:KEVIN CARL MANABE CORIANO
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN CARL
Authorized Official - Middle Name:MANABE
Authorized Official - Last Name:CORIANO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-441-0239
Mailing Address - Street 1:631 JASON ST NE
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97301-2357
Mailing Address - Country:US
Mailing Address - Phone:971-273-0084
Mailing Address - Fax:
Practice Address - Street 1:631 JASON ST NE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301-2357
Practice Address - Country:US
Practice Address - Phone:971-273-0084
Practice Address - Fax:971-701-6224
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-24
Last Update Date:2021-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy