Provider Demographics
NPI:1124560875
Name:MANILA PHYSICAL THERAPY , INC
Entity Type:Organization
Organization Name:MANILA PHYSICAL THERAPY , INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PT
Authorized Official - Prefix:
Authorized Official - First Name:OLIVER
Authorized Official - Middle Name:
Authorized Official - Last Name:TORDECILLAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:941-204-8150
Mailing Address - Street 1:25351 TETHER LN
Mailing Address - Street 2:
Mailing Address - City:PUNTA GORDA
Mailing Address - State:FL
Mailing Address - Zip Code:33983-5917
Mailing Address - Country:US
Mailing Address - Phone:941-204-8150
Mailing Address - Fax:
Practice Address - Street 1:25351 TETHER LN
Practice Address - Street 2:
Practice Address - City:PUNTA GORDA
Practice Address - State:FL
Practice Address - Zip Code:33983-5917
Practice Address - Country:US
Practice Address - Phone:941-204-8150
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-12
Last Update Date:2016-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT18980261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy