Provider Demographics
NPI:1407629256
Name:RENDON, MANICK BUNAG (DPT)
Entity Type:Individual
Prefix:
First Name:MANICK
Middle Name:BUNAG
Last Name:RENDON
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3700 N EDWARDS ST APT 1128
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79705-2722
Mailing Address - Country:US
Mailing Address - Phone:954-803-0756
Mailing Address - Fax:
Practice Address - Street 1:3700 N EDWARDS ST APT 1128
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:TX
Practice Address - Zip Code:79705-2722
Practice Address - Country:US
Practice Address - Phone:954-803-0756
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-02
Last Update Date:2023-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1331669225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist