Basic Information
| Provider Information | |||||||||
| NPI: | 1790125680 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MANEK | ||||||||
| FirstName: | LENA | ||||||||
| MiddleName: | RAMESH | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | D.P.T. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4471 EASTPORT PARK WAY | ||||||||
| Address2: | |||||||||
| City: | PORT ORANGE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 321276041 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3862148124 | ||||||||
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| Practice Location | |||||||||
| Address1: | 6213 SKYLINE DR | ||||||||
| Address2: | |||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770577036 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7138804400 | ||||||||
| FaxNumber: | 7138698637 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/25/2013 | ||||||||
| LastUpdateDate: | 06/25/2013 | ||||||||
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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 | 225100000X | 1230629 | TX | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.