Individual
MR. JAMES MICHAEL MANANSALA HERNANDEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT
Contact information
Practice address
125 KIPP AVE, LODI, NJ 07644-3037
(201) 398-6195
Mailing address
125 KIPP AVE, LODI, NJ 07644-3037
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
40QA01727300
NJ
Other
Enumeration date
06/12/2017
Last updated
06/12/2017
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