MEDICARE: FERDINAND REYES MANGASEP SR. PT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	29115	CA

General Provider Information

NPI Number	:	1245391879
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	FERDINAND REYES MANGASEP SR. PT

Provider Business Mailing Address
First Line	:	7408 EL MORRO WAY
Second Line	:
City	:	BUENA PARK
State	:	CA
Zip	:	90620-2607
Country	:	US
Telephone Number	:	657-465-4659
Fax Number	:	310-862-1837

Provider Business Practice Location Address
First Line	:	6888 LINCOLN AVE STE J2
Second Line	:
City	:	BUENA PARK
State	:	CA
Zip	:	90620-4107
Country	:	US
Telephone Number	:	657-666-9288
Fax Number	:	310-862-1837

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/13/2006
Last Update Date	:	03/10/2020

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