Individual
ESTHER MAMBOWENINGA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
10261 LAKE FOREST DR, VANCLEAVE, MS 39565-2015
(228) 238-6779
Mailing address
10261 LAKE FOREST DR, VANCLEAVE, MS 39565-2015
(228) 238-6779
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
PTA5193
MS
Other
Enumeration date
03/27/2022
Last updated
03/27/2022
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