Provider Demographics
NPI:1174185797
Name:MANASURANGKUL, WATTANAI (ATS)
Entity Type:Individual
Prefix:
First Name:WATTANAI
Middle Name:
Last Name:MANASURANGKUL
Suffix:
Gender:M
Credentials:ATS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2672 AUGUSTA DR
Mailing Address - Street 2:
Mailing Address - City:WHITEHALL
Mailing Address - State:PA
Mailing Address - Zip Code:18052-3836
Mailing Address - Country:US
Mailing Address - Phone:484-788-1538
Mailing Address - Fax:
Practice Address - Street 1:2672 AUGUSTA DR
Practice Address - Street 2:
Practice Address - City:WHITEHALL
Practice Address - State:PA
Practice Address - Zip Code:18052-3836
Practice Address - Country:US
Practice Address - Phone:484-788-1538
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-03
Last Update Date:2019-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic TrainerGroup - Single Specialty