Provider Demographics
NPI:1134476211
Name:MANALANG, MAR AARON REYES (PT)
Entity Type:Individual
Prefix:
First Name:MAR AARON
Middle Name:REYES
Last Name:MANALANG
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1525 W BELMONT AVE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-7176
Mailing Address - Country:US
Mailing Address - Phone:773-525-7868
Mailing Address - Fax:
Practice Address - Street 1:1525 W BELMONT AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657-7176
Practice Address - Country:US
Practice Address - Phone:773-525-7868
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-08
Last Update Date:2012-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070015317225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist