Provider Demographics
NPI:1780876870
Name:MANUEL, RENE SOAN (PT)
Entity type:Individual
Prefix:MR
First Name:RENE
Middle Name:SOAN
Last Name:MANUEL
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:PO BOX 1488
Mailing Address - Street 2:
Mailing Address - City:GROVES
Mailing Address - State:TX
Mailing Address - Zip Code:77619-1488
Mailing Address - Country:US
Mailing Address - Phone:409-466-7139
Mailing Address - Fax:409-729-8114
Practice Address - Street 1:8333 9TH AVE
Practice Address - Street 2:SUITE D
Practice Address - City:PORT ARTHUR
Practice Address - State:TX
Practice Address - Zip Code:77642-8083
Practice Address - Country:US
Practice Address - Phone:409-729-8111
Practice Address - Fax:409-729-8114
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-14
Last Update Date:2007-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1047017225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX98MEOtherBCBS
TX8E0318OtherMEDICARE
TX00690YOtherMEDICARE