Provider Demographics
NPI:1376283812
Name:MANLAPIG, JORDAN DUPITAS (PTA)
Entity Type:Individual
Prefix:
First Name:JORDAN
Middle Name:DUPITAS
Last Name:MANLAPIG
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:777 S 3RD ST APT 2092
Mailing Address - Street 2:
Mailing Address - City:HARRISON
Mailing Address - State:NJ
Mailing Address - Zip Code:07029-2172
Mailing Address - Country:US
Mailing Address - Phone:201-424-4252
Mailing Address - Fax:
Practice Address - Street 1:777 S 3RD ST APT 2092
Practice Address - Street 2:
Practice Address - City:HARRISON
Practice Address - State:NJ
Practice Address - Zip Code:07029-2172
Practice Address - Country:US
Practice Address - Phone:201-424-4252
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-31
Last Update Date:2022-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QB00351300225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant