Provider Demographics
NPI:1386189561
Name:MALABANAN, EMMANUEL (PT)
Entity Type:Individual
Prefix:
First Name:EMMANUEL
Middle Name:
Last Name:MALABANAN
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8100 CAMBRIDGE ST
Mailing Address - Street 2:APT 64
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77054-3171
Mailing Address - Country:US
Mailing Address - Phone:281-433-2720
Mailing Address - Fax:
Practice Address - Street 1:8100 CAMBRIDGE ST
Practice Address - Street 2:APT 64
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77054-3171
Practice Address - Country:US
Practice Address - Phone:281-433-2720
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-27
Last Update Date:2016-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1055564225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist