Provider Demographics
NPI:1225342371
Name:MANZANILLO, MICHERALIN (PT, DPT)
Entity Type:Individual
Prefix:DR
First Name:MICHERALIN
Middle Name:
Last Name:MANZANILLO
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:758 COURTLANDT AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10451-4308
Mailing Address - Country:US
Mailing Address - Phone:718-292-3785
Mailing Address - Fax:
Practice Address - Street 1:758 COURTLANDT AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10451-4308
Practice Address - Country:US
Practice Address - Phone:718-292-3785
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-31
Last Update Date:2012-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY031949225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist