Healthcare Provider Details

I. General information

NPI: 1992092563
Provider Name (Legal Business Name): MGR PHYSICAL THERAPY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/05/2011
Last Update Date: 08/24/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2140 W OLYMPIC BLVD 302
LOS ANGELES CA
90006-2207
US

IV. Provider business mailing address

2140 W OLYMPIC BLVD 302
LOS ANGELES CA
90006-2207
US

V. Phone/Fax

Practice location:
  • Phone: 213-487-7792
  • Fax: 213-487-7823
Mailing address:
  • Phone: 213-487-7792
  • Fax: 213-487-7823

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: MASHEILAPIA MANABAT
Title or Position: PRESIDENT
Credential: O.T
Phone: 213-487-7792