MEDICARE: DAVID MANGER P.T.

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	8911	CA

General Provider Information

NPI Number	:	1700803368
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAVID MANGER P.T.

Provider Business Mailing Address
First Line	:	12816 CORBETT CT
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92130-2439
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3737 MORAGA AVE
Second Line	:	B-117
City	:	SAN DIEGO
State	:	CA
Zip	:	92117-5404
Country	:	US
Telephone Number	:	858-270-0981
Fax Number	:	858-270-2901

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

Provider Enumeration Date	:	07/17/2006
Last Update Date	:	07/08/2007

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Directions to “ DAVID MANGER P.T.” Practice Location

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