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General NPI Number Information
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NPI Number | 1124560875
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Entity Type | Organization
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Legal Business Name | MANILA PHYSICAL THERAPY , INC
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Dates
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Enumeration Date | 11/12/2016
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Last Update Date | 11/12/2016
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Provider Practice Location Address
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Address Line | 25351 TETHER LN
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City | PUNTA GORDA
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State | FL
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Zip | 33983-5917
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Country | US
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Telephone | 941-204-8150
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Fax |
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Provider Business Mailing Address
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Address Line | 25351 TETHER LN
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City | PUNTA GORDA
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State | FL
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Zip | 33983-5917
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Country | US
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Telephone | 941-204-8150
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Fax |
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Authorized Official
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Title or Position | PT
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Name | OLIVER TORDECILLAS
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Credential |
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Telephone | 941-204-8150
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number | PT18980
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License Number State | FL
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