Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251X0800X | Physical Therapist - Orthopedic | 004471 | IA |
NPI | 1053643031 |
---|---|
Provider Name | Susejed Ann Mananquil |
First Address | Fort Dodge, IA 50501-8046 |
Second Address | Fort Dodge, IA 50501-4300 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/02/2010 |
Last Update Date | 02/02/2010 |