Provider Demographics
NPI:1811371768
Name:MANDAWE, EMILYN MACASLANG
Entity Type:Individual
Prefix:
First Name:EMILYN
Middle Name:MACASLANG
Last Name:MANDAWE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5800 W SAMPLE RD APT 206
Mailing Address - Street 2:
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33067-3238
Mailing Address - Country:US
Mailing Address - Phone:325-800-9060
Mailing Address - Fax:
Practice Address - Street 1:1801 SLAYDEN ST APT 7
Practice Address - Street 2:
Practice Address - City:BROWNWOOD
Practice Address - State:TX
Practice Address - Zip Code:76801-5522
Practice Address - Country:US
Practice Address - Phone:325-800-9060
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-09
Last Update Date:2015-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1251893225100000X
NM4573225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist