Individual provider Active NPI

Mia Mae Manalastas, DPT

  • Physical Therapist
  • Chula Vista, CA
National Provider Identifier
1972262541
Registry record updated Dec 10, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
301445 Issued in CA
Practice address
320 Broadway Ste 2
Chula Vista, CA 91910-3502
Phone
(619) 422-0404
Fax
(619) 422-4153
NPI assigned
Dec 10, 2021
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 10, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 301445 CA Primary

Addresses

Primary practice location

320 Broadway Ste 2
Chula Vista, CA 91910-3502

Mailing address

320 Broadway Ste 2
Chula Vista, CA 91910-3502
Phone (619) 422-0404

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20220104002645 CA Practitioner - Physical Therapist in Private Practice 2466843271 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 2021
Medicare assignment
May accept Medicare assignment
Group practices
Rise Physical Therapy IncGroup PAC ID 2062636079, 55 clinicians

Practice addresses (Care Compare)

1016 Broadway
Suite 2
Chula Vista, CA 91911-1803
Phone 858755520014

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
301445CAMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Elnel, Inc. a California Corporation Total Physical Therapy Physical Therapist CurrentSince Dec 13, 2021 Accepting new patients
Rise Physical Therapy Inc Physical Therapist CurrentSince Oct 28, 2024 Accepting new patients
JC Chiropractic, P.C. PastSince Dec 12, 2021 Accepting new patients

Locations

311 Broadway
Chula Vista, CA 91910
Phone (619) 422-0404

1016 Broadway
#2
Chula Vista, CA 91911
Phone 858755520014

2417 Fenton St
Ste A
Chula Vista, CA 91914
Phone (619) 422-0404

320 Broadway
#2
Chula Vista, CA 91910
Phone (619) 422-0404

181 Jamacha Rd
El Cajon, CA 92019
Phone (619) 447-7774

380 Stevens Ave
Ste 314
Solana Beach, CA 92075
Phone 858755520024

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1639094400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1639094400000",
    "number": "1972262541",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "320 BROADWAY STE 2",
            "city": "CHULA VISTA",
            "state": "CA",
            "postal_code": "919103502",
            "telephone_number": "619-422-0404",
            "fax_number": "619-422-4153"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "320 BROADWAY STE 2",
            "city": "CHULA VISTA",
            "state": "CA",
            "postal_code": "919103502",
            "telephone_number": "619-422-0404",
            "fax_number": "619-422-4153"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MANALASTAS",
        "first_name": "MIA",
        "middle_name": "MAE",
        "credential": "DPT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-12-10",
        "last_updated": "2021-12-10",
        "certification_date": "2021-12-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "CA",
            "license": "301445",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chula Vista, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 10, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.