Provider Demographics
NPI:1376026930
Name:RABANAL, MARVIN JOHN MANZANO (PT, DPT)
Entity Type:Individual
Prefix:
First Name:MARVIN JOHN
Middle Name:MANZANO
Last Name:RABANAL
Suffix:
Gender:M
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 1:1363 SUTTER BUTTES ST
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91913-2944
Mailing Address - Country:US
Mailing Address - Phone:619-203-6709
Mailing Address - Fax:
Practice Address - Street 1:860 JAMACHA RD
Practice Address - Street 2:
Practice Address - City:EL CAJON
Practice Address - State:CA
Practice Address - Zip Code:92019-6206
Practice Address - Country:US
Practice Address - Phone:619-573-6373
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-10
Last Update Date:2018-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist