Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251N0400X | Physical Therapist - Neurology | PT16299 | FL |
NPI | 1164944708 |
---|---|
Provider Name | Mayo Manahan Manuel |
First Address | Winter Haven, FL 33880-6300 |
Second Address | Winter Haven, FL 33880-6300 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/07/2017 |
Last Update Date | 30/07/2019 |