MEDICARE: MICHAEL MANGIBUYAT PT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	PT24323	CA

General Provider Information

NPI Number	:	1245213602
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL MANGIBUYAT PT

Provider Business Mailing Address
First Line	:	PO BOX 320305
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94132-0305
Country	:	US
Telephone Number	:	415-682-5514
Fax Number	:	415-682-5573

Provider Business Practice Location Address
First Line	:	1015 SANTIAGO ST
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94116-1706
Country	:	US
Telephone Number	:	415-682-5514
Fax Number	:	415-682-5573

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/21/2005
Last Update Date	:	12/20/2021

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