Provider Demographics
NPI:1780908012
Name:MANGGURAY, SABINIANO FUNA JR (PT)
Entity type:Individual
Prefix:
First Name:SABINIANO
Middle Name:FUNA
Last Name:MANGGURAY
Suffix:JR
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 1:5515 92ND ST
Mailing Address - Street 2:
Mailing Address - City:ELMHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11373-4637
Mailing Address - Country:US
Mailing Address - Phone:347-600-0528
Mailing Address - Fax:
Practice Address - Street 1:6319 AUSTIN ST
Practice Address - Street 2:
Practice Address - City:REGO PARK
Practice Address - State:NY
Practice Address - Zip Code:11374-2936
Practice Address - Country:US
Practice Address - Phone:212-686-6700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-15
Last Update Date:2010-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY031423225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist