Mangostana LLC

Primary specialty

Physical Therapy Clinic/CenterTaxonomy code 261QP2000X

Legal business name

MANGOSTANA LLC

Practice address

1020 Coal Ave SE
Albuquerque, NM 87106-5206

Phone

(505) 221-6475

NPI assigned

Oct 19, 2023

Last updated

Oct 19, 2023By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Karen Chan, PTNPI 1467719542

Title

Owner/ Therapist

Phone

(505) 221-6475

Specialties & licenses 2

Addresses

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Karen Chan, PT

  • Physical Therapist
  • Albuquerque, NM
  • NPI 1467719542
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1697673600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1697673600000",
    "number": "1033991443",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6804 KELLY ANN RD NE",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871093769",
            "telephone_number": "505-221-6475"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1020 COAL AVE SE",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871065206",
            "telephone_number": "505-221-6475"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MANGOSTANA LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-10-19",
        "last_updated": "2023-10-19",
        "certification_date": "2023-10-19",
        "status": "A",
        "authorized_official_last_name": "CHAN",
        "authorized_official_first_name": "KAREN",
        "authorized_official_title_or_position": "OWNER/ THERAPIST",
        "authorized_official_telephone_number": "505-221-6475",
        "authorized_official_credential": "PT"
    },
    "taxonomies": [
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Alexandra Mang
• Aroop Mangalik
• Akash Mangalore, DO
• Diana Patricia Mangan, RN. MSN.
• Jennifer Marie Mangine
• Jennifer Mangum, LADAC
• Brittany Manhan
• Brigitte Marie Mania
• Rex E Manifold, M.D.
• Linda Marie Manke, RN

• Physical Therapy Clinic/Center in Albuquerque, NM
• Providers in Albuquerque, NM by specialty
• Physical Therapy Clinic/Center in New Mexico

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 19, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.