Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 32142 | CA |
NPI | 1003272832 |
---|---|
Provider Name | Mrs. Mary Joy L Manalang |
First Address | Canoga Park, CA 91303-2099 |
Second Address | Canoga Park, CA 91304-4732 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/01/2016 |
Last Update Date | 09/01/2016 |