Alexandra Deptula Manurung, MS, LAT, ATC, PTA

Primary specialty

Physical Therapy AssistantTaxonomy code 225200000X

License

A4337 Issued in MD

Practice address

715 Carter Rd
Rockville, MD 20852-1006

Phone

(410) 340-1046

NPI assigned

Jun 7, 2014

Last updated

Apr 15, 2021By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Science

State licenses

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

{
    "created_epoch": "1402099200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1618444800000",
    "number": "1376956318",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "715 CARTER RD",
            "city": "ROCKVILLE",
            "state": "MD",
            "postal_code": "208521006",
            "telephone_number": "410-340-1046"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "715 CARTER RD",
            "city": "ROCKVILLE",
            "state": "MD",
            "postal_code": "208521006",
            "telephone_number": "410-340-1046"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MANURUNG",
        "first_name": "ALEXANDRA",
        "middle_name": "DEPTULA",
        "credential": "MS, LAT, ATC, PTA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-06-07",
        "last_updated": "2021-04-15",
        "certification_date": "2021-04-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "MD",
            "license": "A00208",
            "primary": false
        },
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "MD",
            "license": "A4337",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mavis Manu
• Manual & Sports Physical Therapy LLC
• Elysha Manuel
• Kayla Manuel
• Kimiko Manuel
• George Manyange
• Josue Manzanares
• Rocco Manziano, L.AC.
• Jeanne Marie Mapeka
• Shontae Marable

• Physical Therapy Assistant in Rockville, MD
• Providers in Rockville, MD by specialty
• Physical Therapy Assistant in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 15, 2021; 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.