Provider Demographics
NPI:1699794768
Name:MANUEL, STEPHEN EVANGELLO MARTIN (PT)
Entity type:Individual
Prefix:MR
First Name:STEPHEN EVANGELLO
Middle Name:MARTIN
Last Name:MANUEL
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 1:5438 ODONOVAN DR
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70808-4364
Mailing Address - Country:US
Mailing Address - Phone:225-769-0818
Mailing Address - Fax:225-769-0819
Practice Address - Street 1:5438 ODONOVAN DR
Practice Address - Street 2:SUITE 100
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70808-4364
Practice Address - Country:US
Practice Address - Phone:225-769-0818
Practice Address - Fax:225-769-0819
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2013-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPT03638F225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist