Active NPI
Margie Bongat Manzano
- Physical Therapist
- Walla Walla, WA
National Provider Identifier
1326326562
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- PT 10457
- Practice address
- 420 SE Myra Rd.
Walla Walla, WA 99324-1796 - Phone
- (509) 529-4480
- NPI assigned
- Jul 21, 2011
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | PT 10457 | WA | Primary |
Addresses
Primary practice location
420 SE Myra Rd.
Walla Walla, WA 99324-1796
Mailing address
706 Whitman Street
Walla Walla, WA 99362
Phone (509) 200-2964
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PT 10457 | WA | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1311206400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1311206400000",
"number": "1326326562",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "706 WHITMAN STREET",
"city": "WALLA WALLA",
"state": "WA",
"postal_code": "99362",
"telephone_number": "509-200-2964"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "420 SE MYRA RD.",
"city": "WALLA WALLA",
"state": "WA",
"postal_code": "993241796",
"telephone_number": "509-529-4480"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MANZANO",
"first_name": "MARGIE",
"middle_name": "BONGAT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2011-07-21",
"last_updated": "2011-07-21",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "WA",
"license": "PT 10457",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Walla Walla, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.