Provider Demographics
NPI:1265580617
Name:MANALO, KHELMER ESTANISLAO (PHYSICAL THERAPIST)
Entity type:Individual
Prefix:
First Name:KHELMER
Middle Name:ESTANISLAO
Last Name:MANALO
Suffix:
Gender:M
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2249 SARAH CT
Mailing Address - Street 2:
Mailing Address - City:PINOLE
Mailing Address - State:CA
Mailing Address - Zip Code:94564-1861
Mailing Address - Country:US
Mailing Address - Phone:510-541-9235
Mailing Address - Fax:925-387-0084
Practice Address - Street 1:2249 SARAH CT
Practice Address - Street 2:
Practice Address - City:PINOLE
Practice Address - State:CA
Practice Address - Zip Code:94564-1861
Practice Address - Country:US
Practice Address - Phone:510-541-9235
Practice Address - Fax:925-387-0084
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2009-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA28216225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist