Individual
WARREN C MANGULABNAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
RPT
Contact information
Practice address
33620 FIVE MILE RD STE A, LIVONIA, MI 48154-2866
(248) 957-8930
(313) 541-1171
Mailing address
28720 BAYBERRY CT W, LIVONIA, MI 48154-3867
(248) 396-9193
(313) 741-1171
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
5501009909
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5501009909
PHYSICAL THERAPY LICENSE
MI
Enumeration date
02/29/2016
Last updated
08/26/2022
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