Provider Demographics
NPI:1184999393
Name:MANIGBAS, ROMULO G (PT)
Entity type:Individual
Prefix:MR
First Name:ROMULO
Middle Name:G
Last Name:MANIGBAS
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 1:16089 POPPYSEED CIR UNIT 2008
Mailing Address - Street 2:
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33484-6314
Mailing Address - Country:US
Mailing Address - Phone:561-496-7993
Mailing Address - Fax:561-496-0589
Practice Address - Street 1:5757 N SHERIDAN RD
Practice Address - Street 2:APT 16G
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60660-4746
Practice Address - Country:US
Practice Address - Phone:863-484-2860
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-21
Last Update Date:2012-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070.017697225100000X
FLPT25128225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist