Provider Demographics
NPI:1841551777
Name:MANALESE, ATILANO MANUELITO MENDOZA (RPT)
Entity type:Individual
Prefix:MR
First Name:ATILANO MANUELITO
Middle Name:MENDOZA
Last Name:MANALESE
Suffix:
Gender:M
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18763 FARMINGTON RD
Mailing Address - Street 2:
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48152-3262
Mailing Address - Country:US
Mailing Address - Phone:248-426-0572
Mailing Address - Fax:
Practice Address - Street 1:18763 FARMINGTON RD
Practice Address - Street 2:
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48152-3262
Practice Address - Country:US
Practice Address - Phone:248-426-0572
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-07
Last Update Date:2024-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501011779225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5501011779OtherPHYSICAL THERAPIST LICENSE