Provider Demographics
NPI:1477650562
Name:MANIBUSAN, HIDELISA CATHALINA (PT)
Entity Type:Individual
Prefix:
First Name:HIDELISA
Middle Name:CATHALINA
Last Name:MANIBUSAN
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 1:1500 OWENS ST STE 400
Mailing Address - Street 2:BOX 0625
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94158-2335
Mailing Address - Country:US
Mailing Address - Phone:415-353-7598
Mailing Address - Fax:415-353-9554
Practice Address - Street 1:1500 OWENS ST STE 400
Practice Address - Street 2:BOX 0625
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94158-2335
Practice Address - Country:US
Practice Address - Phone:415-353-7598
Practice Address - Fax:415-353-9554
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2012-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL22607225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL000467700Medicaid
FLY132VOtherBLUE CROSS BLUE SHIELD
FL000467700Medicaid
FLP00852819Medicare PIN