Provider Demographics
NPI:1841431095
Name:MANCHESTER THERAPY GROUP
Entity Type:Organization
Organization Name:MANCHESTER THERAPY GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ERWIN
Authorized Official - Middle Name:C
Authorized Official - Last Name:GALICINAO
Authorized Official - Suffix:
Authorized Official - Credentials:RPT
Authorized Official - Phone:714-562-0966
Mailing Address - Street 1:7212 ORANGETHORPE AVE
Mailing Address - Street 2:SUITE 3
Mailing Address - City:BUENA PARK
Mailing Address - State:CA
Mailing Address - Zip Code:90621-3341
Mailing Address - Country:US
Mailing Address - Phone:714-562-0966
Mailing Address - Fax:714-562-0967
Practice Address - Street 1:7212 ORANGETHORPE AVE
Practice Address - Street 2:SUITE 3
Practice Address - City:BUENA PARK
Practice Address - State:CA
Practice Address - Zip Code:90621-3341
Practice Address - Country:US
Practice Address - Phone:714-562-0966
Practice Address - Fax:714-562-0967
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-18
Last Update Date:2009-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT 35376225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty