Healthcare Provider Details

I. General information

NPI: 1568684447
Provider Name (Legal Business Name): SHARON SATOE MANZUK PT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SHARON SATOE TOTTORI PT

II. Dates (important events)

Enumeration Date: 05/02/2007
Last Update Date: 07/19/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4402 VANDEVER AVE
SAN DIEGO CA
92120-3316
US

IV. Provider business mailing address

4402 VANDEVER AVE
SAN DIEGO CA
92120-3316
US

V. Phone/Fax

Practice location:
  • Phone: 619-516-7221
  • Fax:
Mailing address:
  • Phone: 619-516-7221
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251E1200X
TaxonomyErgonomics Physical Therapist
License NumberPT25101
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: