Provider Demographics
NPI:1720385719
Name:MANRIQUE, PATRICK G (DPT)
Entity type:Individual
Prefix:
First Name:PATRICK
Middle Name:G
Last Name:MANRIQUE
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:TRIPLER ARMY MEDICAL CENTER
Mailing Address - Street 2:1 JARRETT WHITE ROAD
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96818
Mailing Address - Country:US
Mailing Address - Phone:888-683-2778
Mailing Address - Fax:
Practice Address - Street 1:TRIPLER ARMY MEDICAL CENTER
Practice Address - Street 2:1 JARRETT WHITE ROAD
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96818
Practice Address - Country:US
Practice Address - Phone:888-683-2778
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-02-28
Last Update Date:2024-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05010787A225100000X
IL070018334225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL216860049Medicare PIN
IL216859181Medicare PIN