Provider Demographics
NPI:1427381961
Name:MANALASTAS, KATHLEEN SUSANNE (DPT)
Entity Type:Individual
Prefix:DR
First Name:KATHLEEN
Middle Name:SUSANNE
Last Name:MANALASTAS
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:KATHLEEN
Other - Middle Name:SUSANNE
Other - Last Name:BANNISTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:1838 GREEN TREE ROAD
Mailing Address - Street 2:SUITE 290
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21208
Mailing Address - Country:US
Mailing Address - Phone:410-653-9813
Mailing Address - Fax:410-653-9815
Practice Address - Street 1:1838 GREEN TREE ROAD
Practice Address - Street 2:SUITE 290
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21208
Practice Address - Country:US
Practice Address - Phone:410-653-9813
Practice Address - Fax:410-653-9815
Is Sole Proprietor?:No
Enumeration Date:2009-09-16
Last Update Date:2011-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD23263225100000X
NY031542225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist