Provider Demographics
NPI:1396990859
Name:MANGINSAY, KEN (PT)
Entity type:Individual
Prefix:
First Name:KEN
Middle Name:
Last Name:MANGINSAY
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 1:2075 COUNTY ROAD 4260
Mailing Address - Street 2:
Mailing Address - City:WOODVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75979-6271
Mailing Address - Country:US
Mailing Address - Phone:409-283-2114
Mailing Address - Fax:
Practice Address - Street 1:2075 COUNTY ROAD 4260
Practice Address - Street 2:
Practice Address - City:WOODVILLE
Practice Address - State:TX
Practice Address - Zip Code:75979-6271
Practice Address - Country:US
Practice Address - Phone:409-283-2114
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-25
Last Update Date:2008-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1119741225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist