Basic Information
| Provider Information | |||||||||
| NPI: | 1275868663 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MANNENBACH | ||||||||
| FirstName: | ANA | ||||||||
| MiddleName: | KARLA | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | P.T., D.P.T. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 610 HIGH ST | ||||||||
| Address2: | |||||||||
| City: | OREGON CITY | ||||||||
| State: | OR | ||||||||
| PostalCode: | 970452241 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5036578903 | ||||||||
| FaxNumber: | 5036504302 | ||||||||
| Practice Location | |||||||||
| Address1: | 1910 E BARNETT RD | ||||||||
| Address2: | SUITE 103 | ||||||||
| City: | MEDFORD | ||||||||
| State: | OR | ||||||||
| PostalCode: | 975048672 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5036578903 | ||||||||
| FaxNumber: | 5036504302 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/02/2009 | ||||||||
| LastUpdateDate: | 02/17/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2251P0200X | 6000 | OR | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Pediatrics | 225100000X | 6000 | OR | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.