Provider Demographics
NPI:1427121649
Name:MANRIQUE, HAROLD PAUL (MPT)
Entity type:Individual
Prefix:MR
First Name:HAROLD
Middle Name:PAUL
Last Name:MANRIQUE
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 ODYSSEY STE 260
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92618-7701
Mailing Address - Country:US
Mailing Address - Phone:949-748-7806
Mailing Address - Fax:949-709-4064
Practice Address - Street 1:22 ODYSSEY STE 260
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92618-7701
Practice Address - Country:US
Practice Address - Phone:949-748-7806
Practice Address - Fax:949-748-7892
Is Sole Proprietor?:No
Enumeration Date:2006-11-16
Last Update Date:2023-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT28703225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist