Provider Demographics
NPI:1659992980
Name:LUMBAD, REI EMMANUEL (PTA)
Entity Type:Individual
Prefix:
First Name:REI EMMANUEL
Middle Name:
Last Name:LUMBAD
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8702 VALLEY VIEW ST APT 22
Mailing Address - Street 2:
Mailing Address - City:BUENA PARK
Mailing Address - State:CA
Mailing Address - Zip Code:90620-3552
Mailing Address - Country:US
Mailing Address - Phone:714-851-3569
Mailing Address - Fax:
Practice Address - Street 1:8702 VALLEY VIEW ST APT 22
Practice Address - Street 2:
Practice Address - City:BUENA PARK
Practice Address - State:CA
Practice Address - Zip Code:90620-3552
Practice Address - Country:US
Practice Address - Phone:714-851-3569
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-28
Last Update Date:2020-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA49532225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant