Basic Information
| Provider Information | |||||||||
| NPI: | 1780878652 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MANGARELLI-KALLENBERG | ||||||||
| FirstName: | LAURA | ||||||||
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| Credential: | P.T. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1139 SPANISH MOSS DR | ||||||||
| Address2: | |||||||||
| City: | SAVANNAH | ||||||||
| State: | TX | ||||||||
| PostalCode: | 762277781 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9723471586 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2535 W OAK ST | ||||||||
| Address2: | |||||||||
| City: | DENTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 762012331 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9403822649 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/04/2007 | ||||||||
| LastUpdateDate: | 05/30/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 1137727 | TX | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | 2251X0800X | 1137727 | TX | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Orthopedic |
No ID Information.