Provider Demographics
NPI:1336500719
Name:LANSANG, MARIEL JACQUES (PT, DPT)
Entity Type:Individual
Prefix:
First Name:MARIEL
Middle Name:JACQUES
Last Name:LANSANG
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 1:11721 186TH ST
Mailing Address - Street 2:
Mailing Address - City:ARTESIA
Mailing Address - State:CA
Mailing Address - Zip Code:90701-5520
Mailing Address - Country:US
Mailing Address - Phone:714-486-7140
Mailing Address - Fax:
Practice Address - Street 1:2700 N MAIN ST STE 945
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92705-6678
Practice Address - Country:US
Practice Address - Phone:714-542-1234
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-14
Last Update Date:2018-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics