Provider Demographics
NPI:1457745218
Name:MANJU NATH MDPA
Entity Type:Organization
Organization Name:MANJU NATH MDPA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MANJU
Authorized Official - Middle Name:
Authorized Official - Last Name:NATH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:214-499-1217
Mailing Address - Street 1:PO BOX 8337
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79114-8337
Mailing Address - Country:US
Mailing Address - Phone:806-355-6593
Mailing Address - Fax:806-352-8774
Practice Address - Street 1:3144 W 28TH AVE STE C
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79109-3169
Practice Address - Country:US
Practice Address - Phone:806-355-6593
Practice Address - Fax:806-352-8774
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-19
Last Update Date:2015-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ3560208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty