Organization
MANGOSTANA LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KAREN CHAN PT (OWNER/ THERAPIST)
(505) 221-6475
Entity
Organization
Contact information
Practice address
1020 COAL AVE SE, ALBUQUERQUE, NM 87106-5206
(505) 221-6475
Mailing address
6804 KELLY ANN RD NE, ALBUQUERQUE, NM 87109-3769
(505) 221-6475
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
—
—
261QP2000X
Physical Therapy Clinic/Center
Primary
—
—
Other
Enumeration date
10/19/2023
Last updated
10/19/2023
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