Provider Demographics
NPI:1477858124
Name:MANNA PEDIATRIC THERAPY PLUS
Entity Type:Organization
Organization Name:MANNA PEDIATRIC THERAPY PLUS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JEE
Authorized Official - Middle Name:AGUILOS
Authorized Official - Last Name:DELLOTA
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:956-572-1908
Mailing Address - Street 1:35 BUSINESS DR
Mailing Address - Street 2:SUITES C
Mailing Address - City:BROWNSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78521-4499
Mailing Address - Country:US
Mailing Address - Phone:956-572-1908
Mailing Address - Fax:888-588-3234
Practice Address - Street 1:35 BUSINESS DR
Practice Address - Street 2:SUITES C
Practice Address - City:BROWNSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78521-4499
Practice Address - Country:US
Practice Address - Phone:956-572-1908
Practice Address - Fax:888-588-3234
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-11
Last Update Date:2013-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1122083225100000X
TX112254225X00000X
TX105254235Z00000X
TX17120235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX204888601OtherTPI