Jose Ichiro Manabat, P.T.A

Primary specialty

Physical Therapy AssistantTaxonomy code 225200000X

License

225200000X Issued in CA

Practice address

11940 Greenbluff Way
Yucaipa, CA 92399-3476

Phone

(909) 790-0861

NPI assigned

Jun 27, 2013

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1372291200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1385164800000",
    "number": "1104266766",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11940 GREENBLUFF WAY",
            "city": "YUCAIPA",
            "state": "CA",
            "postal_code": "923993476"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11940 GREENBLUFF WAY",
            "city": "YUCAIPA",
            "state": "CA",
            "postal_code": "923993476",
            "telephone_number": "909-790-0861"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MANABAT",
        "first_name": "JOSE",
        "middle_name": "ICHIRO",
        "credential": "P.T.A",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2013-06-27",
        "last_updated": "2013-11-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "CA",
            "license": "225200000X",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mary Elizabeth Mahathey
• Khalid H Mahfouz, RPH
• Phoebe Mai
• Vincent Mak
• Hanah Jaymes Malcolm
• Felbert Balandra Maningo, RPH
• Ezra Jeremiah Ruaw Mao
• Logan Alexander Marceau
• Steven Markham, DDS
• Samantha Elvira Murguia Marshall

• Physical Therapy Assistant in Yucaipa, CA
• Providers in Yucaipa, CA by specialty
• Physical Therapy Assistant in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 23, 2013; 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.