Provider Demographics
NPI:1639545569
Name:DE VERA, MANUEL RONALD BIANGCO (PT)
Entity Type:Individual
Prefix:MR
First Name:MANUEL RONALD
Middle Name:BIANGCO
Last Name:DE VERA
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
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Mailing Address - Street 1:12413 JUDSON RD STE 260
Mailing Address - Street 2:
Mailing Address - City:LIVE OAK
Mailing Address - State:TX
Mailing Address - Zip Code:78233-3262
Mailing Address - Country:US
Mailing Address - Phone:210-614-7953
Mailing Address - Fax:956-687-4554
Practice Address - Street 1:2140 BABCOCK RD STE 130
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-4400
Practice Address - Country:US
Practice Address - Phone:210-614-7953
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-14
Last Update Date:2022-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1260540225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist