Provider Demographics
NPI:1164862900
Name:MANGULABNAN, JANESSA (PT)
Entity Type:Individual
Prefix:
First Name:JANESSA
Middle Name:
Last Name:MANGULABNAN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26803 WHITE PLAINS WAY
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:FL
Mailing Address - Zip Code:34748-1302
Mailing Address - Country:US
Mailing Address - Phone:606-213-7247
Mailing Address - Fax:
Practice Address - Street 1:26803 WHITE PLAINS WAY
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:FL
Practice Address - Zip Code:34748-1302
Practice Address - Country:US
Practice Address - Phone:606-213-7247
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-25
Last Update Date:2013-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT 28220225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist