Provider Demographics
NPI:1285232561
Name:MANA MOBILITY PHYSICAL THERAPY
Entity type:Organization
Organization Name:MANA MOBILITY PHYSICAL THERAPY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:
Authorized Official - Last Name:GARAKIAN
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT
Authorized Official - Phone:510-432-8278
Mailing Address - Street 1:67-1185 MAMALAHOA HWY D-104
Mailing Address - Street 2:#153
Mailing Address - City:KAMUELA
Mailing Address - State:HI
Mailing Address - Zip Code:96743-7505
Mailing Address - Country:US
Mailing Address - Phone:510-432-8278
Mailing Address - Fax:
Practice Address - Street 1:1267 WILLIS ST STE 200
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96001-0400
Practice Address - Country:US
Practice Address - Phone:510-432-8278
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-09
Last Update Date:2020-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy