Provider Demographics
NPI:1982066312
Name:MANALO, IRA EDWARD CUDALA (DPT)
Entity Type:Individual
Prefix:DR
First Name:IRA EDWARD
Middle Name:CUDALA
Last Name:MANALO
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:480 JOHNSON RD
Mailing Address - Street 2:SUITE 303
Mailing Address - City:WASHINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:15301-8936
Mailing Address - Country:US
Mailing Address - Phone:724-223-2061
Mailing Address - Fax:724-223-2064
Practice Address - Street 1:480 JOHNSON RD
Practice Address - Street 2:SUITE 303
Practice Address - City:WASHINGTON
Practice Address - State:PA
Practice Address - Zip Code:15301-8936
Practice Address - Country:US
Practice Address - Phone:724-223-2061
Practice Address - Fax:724-223-2064
Is Sole Proprietor?:No
Enumeration Date:2016-03-24
Last Update Date:2016-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT0250232251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic