Individual
IVA MANANQUIL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPTA
Contact information
Practice address
2580 PRUDEN BLVD, SUFFOLK, VA 23434-4229
(757) 934-2363
Mailing address
3633 SMOKEY CHAMBER DR, VIRGINIA BEACH, VA 23462-6811
(757) 513-2146
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
2306605252
VA
Other
Enumeration date
02/27/2019
Last updated
02/27/2019
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