Provider Demographics
NPI:1851999643
Name:MANGULABNAN, ROMKER MAMARIL (PT)
Entity Type:Individual
Prefix:MR
First Name:ROMKER
Middle Name:MAMARIL
Last Name:MANGULABNAN
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9018 ABBEY LN APT 2168
Mailing Address - Street 2:
Mailing Address - City:DES PLAINES
Mailing Address - State:IL
Mailing Address - Zip Code:60016-5063
Mailing Address - Country:US
Mailing Address - Phone:432-207-2160
Mailing Address - Fax:
Practice Address - Street 1:415 W GOLF RD STE 52
Practice Address - Street 2:
Practice Address - City:ARLINGTON HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60005-3923
Practice Address - Country:US
Practice Address - Phone:432-207-2160
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-13
Last Update Date:2020-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070.025618225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist