Healthcare Provider Details

I. General information

NPI: 1891316741
Provider Name (Legal Business Name): KATRINA MANANQUIL PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/01/2020
Last Update Date: 05/02/2023
Certification Date: 05/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4341 PIEDMONT AVE STE 201
OAKLAND CA
94611-4792
US

IV. Provider business mailing address

7567 AMADOR VALLEY BLVD STE 201
DUBLIN CA
94568-2443
US

V. Phone/Fax

Practice location:
  • Phone: 510-547-1630
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number304003
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: