Individual
MR. CHARLES ROBERT MANGUS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
P.T.
Contact information
Practice address
111 S 5TH ST, DOUGLAS, WY 82633-2434
(307) 358-9464
(307) 358-9330
Mailing address
111 S 5TH ST, DOUGLAS, WY 82633-2434
(307) 358-9464
(307) 358-9330
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT-246
WY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
104269600
—
WY
Enumeration date
04/14/2006
Last updated
10/17/2012
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