Provider Demographics
NPI:1265859839
Name:SANGALANG, MANUEL
Entity Type:Individual
Prefix:
First Name:MANUEL
Middle Name:
Last Name:SANGALANG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2291 W 205TH ST
Mailing Address - Street 2:101
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90501-1451
Mailing Address - Country:US
Mailing Address - Phone:310-329-3645
Mailing Address - Fax:310-328-3745
Practice Address - Street 1:2291 W 205TH ST
Practice Address - Street 2:101
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90501-1451
Practice Address - Country:US
Practice Address - Phone:310-329-3645
Practice Address - Fax:310-328-3745
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-21
Last Update Date:2014-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT 40077225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist