Provider Demographics
NPI:1295325868
Name:MANALO-NUNEZ, MYLA JOANNE (PTA)
Entity type:Individual
Prefix:
First Name:MYLA JOANNE
Middle Name:
Last Name:MANALO-NUNEZ
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3330 OLD CARRIAGE DR
Mailing Address - Street 2:
Mailing Address - City:EASTON
Mailing Address - State:PA
Mailing Address - Zip Code:18045-3131
Mailing Address - Country:US
Mailing Address - Phone:908-249-1289
Mailing Address - Fax:
Practice Address - Street 1:1896 LEITHSVILLE RD
Practice Address - Street 2:
Practice Address - City:HELLERTOWN
Practice Address - State:PA
Practice Address - Zip Code:18055-2505
Practice Address - Country:US
Practice Address - Phone:610-838-7901
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-19
Last Update Date:2021-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PATEI005513225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant