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NPI Code Detail

MEDICARE: MICHAEL MANINANG PT

MEDICARE:   MICHAEL  MANINANG  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
1225100000XPhysical Therapist070007656IL

General Provider Information

NPI Number : 1376671826
Entity Type Code : Individual
Provider Name (Legal Business Name) : MICHAEL MANINANG PT
Provider Business Mailing Address
First Line : 25630 S ROSE LN
Second Line :
City : MONEE
State : IL
Zip : 60449-8727
Country : US
Telephone Number : 708-235-1988
Fax Number :
Provider Business Practice Location Address
First Line : 2335 W 95TH ST
Second Line :
City : CHICAGO
State : IL
Zip : 60643-1003
Country : US
Telephone Number : 773-755-7566
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/28/2007
Last Update Date : 06/14/2010

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