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General NPI Number Information
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NPI Number | 1962756049
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Entity Type | Individual
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Provider Name | FREIDRICH MANGULABNAN PT, CLT
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Gender | Male
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Dates
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Enumeration Date | 10/29/2012
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Last Update Date | 10/29/2012
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Provider Practice Location Address
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Address Line | 240 HOSPITAL RD
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City | WHITESBURG
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State | KY
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Zip | 41858-7627
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Country | US
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Telephone | 606-633-3524
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Fax |
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Provider Business Mailing Address
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Address Line | 117 2ND ST APT. 7
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City | PIKEVILLE
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State | KY
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Zip | 41501-3991
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Country | US
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Telephone | 606-213-7248
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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 | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 5152
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License Number State | KY
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