Provider Demographics
NPI:1164612644
Name:WANG, MANN S (MS, RPT)
Entity Type:Individual
Prefix:MS
First Name:MANN
Middle Name:S
Last Name:WANG
Suffix:
Gender:F
Credentials:MS, RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:46923 WARM SPRINGS BLVD
Mailing Address - Street 2:#103
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94539-7914
Mailing Address - Country:US
Mailing Address - Phone:510-651-6215
Mailing Address - Fax:
Practice Address - Street 1:46923 WARM SPRINGS BLVD
Practice Address - Street 2:#103
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94539-7914
Practice Address - Country:US
Practice Address - Phone:510-651-6215
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-31
Last Update Date:2007-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOPT123250225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist