Provider Demographics
NPI:1265580492
Name:MANINGAS, ANTONIO VALIENTE JR (RPT)
Entity type:Individual
Prefix:
First Name:ANTONIO
Middle Name:VALIENTE
Last Name:MANINGAS
Suffix:JR
Gender:M
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1519 SHAGBARK DR
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60490-6582
Mailing Address - Country:US
Mailing Address - Phone:630-226-0806
Mailing Address - Fax:
Practice Address - Street 1:2804 75TH ST
Practice Address - Street 2:
Practice Address - City:WOODRIDGE
Practice Address - State:IL
Practice Address - Zip Code:60517-2850
Practice Address - Country:US
Practice Address - Phone:630-963-9200
Practice Address - Fax:630-963-9275
Is Sole Proprietor?:No
Enumeration Date:2007-01-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist