Healthcare Provider Details

I. General information

NPI: 1457745218
Provider Name (Legal Business Name): MANJU NATH MDPA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/19/2015
Last Update Date: 03/19/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3144 W 28TH AVE STE C
AMARILLO TX
79109-3169
US

IV. Provider business mailing address

PO BOX 8337
AMARILLO TX
79114-8337
US

V. Phone/Fax

Practice location:
  • Phone: 806-355-6593
  • Fax: 806-352-8774
Mailing address:
  • Phone: 806-355-6593
  • Fax: 806-352-8774

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberJ3560
License Number StateTX

VIII. Authorized Official

Name: DR. MANJU NATH
Title or Position: PRESIDENT
Credential: MD
Phone: 214-499-1217