Provider Demographics
NPI:1992092563
Name:MGR PHYSICAL THERAPY INC
Entity type:Organization
Organization Name:MGR PHYSICAL THERAPY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MASHEILAPIA
Authorized Official - Middle Name:
Authorized Official - Last Name:MANABAT
Authorized Official - Suffix:
Authorized Official - Credentials:OT
Authorized Official - Phone:213-487-7792
Mailing Address - Street 1:2140 W OLYMPIC BLVD
Mailing Address - Street 2:302
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90006-2207
Mailing Address - Country:US
Mailing Address - Phone:213-487-7792
Mailing Address - Fax:213-487-7823
Practice Address - Street 1:2140 W OLYMPIC BLVD
Practice Address - Street 2:302
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90006-2207
Practice Address - Country:US
Practice Address - Phone:213-487-7792
Practice Address - Fax:213-487-7823
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-05
Last Update Date:2015-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty