Provider Demographics
NPI:1629310263
Name:MANGOME SENATI, MELIXA ENITH (DPT)
Entity type:Individual
Prefix:
First Name:MELIXA
Middle Name:ENITH
Last Name:MANGOME SENATI
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 250228
Mailing Address - Street 2:
Mailing Address - City:AGUADILLA
Mailing Address - State:PR
Mailing Address - Zip Code:00604-0228
Mailing Address - Country:US
Mailing Address - Phone:787-265-0255
Mailing Address - Fax:787-832-8326
Practice Address - Street 1:24 SEVERIANO CUEVAS
Practice Address - Street 2:OFICINA 105
Practice Address - City:AGUADILLA
Practice Address - State:PR
Practice Address - Zip Code:00603-5762
Practice Address - Country:US
Practice Address - Phone:787-891-2470
Practice Address - Fax:787-658-6113
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-21
Last Update Date:2020-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR000903225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist