Individual
MR. EMMANUEL REQUENA SR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
20 JOHN KISSINGER DR, WABASH, IN 46992-1648
(260) 274-0868
Mailing address
9219 BARBARA LN, FORT WAYNE, IN 46804-4702
(260) 579-1748
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
06004053A
IN
Other
Enumeration date
09/10/2014
Last updated
09/10/2014
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