Provider Demographics
NPI:1669085403
Name:MANA MOBILE PHYSICAL THERAPY, P.C.
Entity type:Organization
Organization Name:MANA MOBILE PHYSICAL THERAPY, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/PHYSICAL THERAPIST
Authorized Official - Prefix:DR
Authorized Official - First Name:GARRET
Authorized Official - Middle Name:LESTER
Authorized Official - Last Name:WONG
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT
Authorized Official - Phone:310-853-3948
Mailing Address - Street 1:950 VIRGINIA ST APT 102
Mailing Address - Street 2:
Mailing Address - City:EL SEGUNDO
Mailing Address - State:CA
Mailing Address - Zip Code:90245-2170
Mailing Address - Country:US
Mailing Address - Phone:310-853-3948
Mailing Address - Fax:
Practice Address - Street 1:950 VIRGINIA ST APT 102
Practice Address - Street 2:
Practice Address - City:EL SEGUNDO
Practice Address - State:CA
Practice Address - Zip Code:90245-2170
Practice Address - Country:US
Practice Address - Phone:310-853-3948
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-30
Last Update Date:2020-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty