Provider Demographics
NPI:1407865777
Name:MANABAT, CHONA G (PT)
Entity Type:Individual
Prefix:MRS
First Name:CHONA
Middle Name:G
Last Name:MANABAT
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24922 EMERALD AVE
Mailing Address - Street 2:
Mailing Address - City:PLAINFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60585-2968
Mailing Address - Country:US
Mailing Address - Phone:815-272-4563
Mailing Address - Fax:815-436-3848
Practice Address - Street 1:24922 EMERALD AVE
Practice Address - Street 2:
Practice Address - City:PLAINFIELD
Practice Address - State:IL
Practice Address - Zip Code:60585-2968
Practice Address - Country:US
Practice Address - Phone:815-272-4563
Practice Address - Fax:815-436-3848
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL70011748225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0039941191OtherBCBS PROVIDER #