Healthcare Provider Details

I. General information

NPI: 1265580617
Provider Name (Legal Business Name): KHELMER ESTANISLAO MANALO PHYSICAL THERAPIST
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/08/2007
Last Update Date: 10/02/2026
Certification Date: 10/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 MUIR RD
MARTINEZ CA
94553-4614
US

IV. Provider business mailing address

2249 SARAH CT
PINOLE CA
94564-1861
US

V. Phone/Fax

Practice location:
  • Phone: 510-890-5462
  • Fax:
Mailing address:
  • Phone: 510-541-9235
  • Fax: 925-387-0084

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number28216
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: