Provider Demographics
NPI:1669658852
Name:MANGAN PHYSICAL THERAPY INC
Entity Type:Organization
Organization Name:MANGAN PHYSICAL THERAPY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:MANGAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:951-296-0400
Mailing Address - Street 1:29377 RANCHO CALIFORNIA RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92591-5289
Mailing Address - Country:US
Mailing Address - Phone:951-296-0400
Mailing Address - Fax:951-296-5162
Practice Address - Street 1:29377 RANCHO CALIFORNIA RD
Practice Address - Street 2:SUITE 100
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92591-5289
Practice Address - Country:US
Practice Address - Phone:951-296-0400
Practice Address - Fax:951-296-5162
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-17
Last Update Date:2016-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA243512251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAOPT243510Medicare PIN