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General NPI Number Information
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NPI Number | 1952342602
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Entity Type | Individual
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Provider Name | JOSE MANULETE FELICIANO III PT
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Gender | Male
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Dates
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Enumeration Date | 06/10/2006
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Last Update Date | 03/01/2011
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Provider Practice Location Address
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Address Line | 5576 FOXTAIL LOOP
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City | CARLSBAD
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State | CA
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Zip | 92010-7152
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Country | US
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Telephone | 760-889-5557
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Fax |
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Provider Business Mailing Address
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Address Line | 5576 FOXTAIL LOOP
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City | CARLSBAD
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State | CA
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Zip | 92010-7152
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Country | US
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Telephone | 760-889-5557
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2251G0304X
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Taxonomy Name | Geriatric Physical Therapist
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License Number | PT26095
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 2251X0800X
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Taxonomy Name | Orthopedic Physical Therapist
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License Number | PT26095
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License Number State | CA
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