Provider Demographics
NPI:1588297832
Name:MANALANG, DENNIS IMPERIAL (PT)
Entity type:Individual
Prefix:MR
First Name:DENNIS
Middle Name:IMPERIAL
Last Name:MANALANG
Suffix:
Gender:M
Credentials:PT
Other - Prefix:MR
Other - First Name:DENNIS
Other - Middle Name:
Other - Last Name:MANALANG
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PT
Mailing Address - Street 1:1087 MACE AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10469-4416
Mailing Address - Country:US
Mailing Address - Phone:917-770-6777
Mailing Address - Fax:
Practice Address - Street 1:1087 MACE AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10469-4416
Practice Address - Country:US
Practice Address - Phone:917-770-6777
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-14
Last Update Date:2020-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY031730225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist