Individual
JOSE ICHIRO MANABAT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
P.T.A
Contact information
Practice address
11940 GREENBLUFF WAY, YUCAIPA, CA 92399-3476
(909) 790-0861
Mailing address
11940 GREENBLUFF WAY, YUCAIPA, CA 92399-3476
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
225200000X
CA
Other
Enumeration date
06/27/2013
Last updated
11/23/2013
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