Provider Demographics
NPI:1952342602
Name:FELICIANO, JOSE MANULETE III (PT)
Entity Type:Individual
Prefix:MR
First Name:JOSE
Middle Name:MANULETE
Last Name:FELICIANO
Suffix:III
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:5576 FOXTAIL LOOP
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92010-7152
Mailing Address - Country:US
Mailing Address - Phone:760-889-5557
Mailing Address - Fax:
Practice Address - Street 1:5576 FOXTAIL LOOP
Practice Address - Street 2:
Practice Address - City:CARLSBAD
Practice Address - State:CA
Practice Address - Zip Code:92010-7152
Practice Address - Country:US
Practice Address - Phone:760-889-5557
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-10
Last Update Date:2011-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT260952251G0304X, 2251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatrics
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic