Provider Demographics
NPI:1164729117
Name:MANAPSAL, JESUS JR (PT)
Entity Type:Individual
Prefix:
First Name:JESUS
Middle Name:
Last Name:MANAPSAL
Suffix:JR
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 1:1945 N ROCK RD
Mailing Address - Street 2:1318
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67206-1249
Mailing Address - Country:US
Mailing Address - Phone:336-200-3805
Mailing Address - Fax:
Practice Address - Street 1:7101 E 21ST ST N
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67206-1044
Practice Address - Country:US
Practice Address - Phone:316-684-8018
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-26
Last Update Date:2011-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS11-04027225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist