Provider Demographics
NPI:1538592167
Name:MANOSAR, PAUL LYLE (PT)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:LYLE
Last Name:MANOSAR
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:901 OAK PARK BLVD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:PISMO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:93449-3408
Mailing Address - Country:US
Mailing Address - Phone:805-481-8272
Mailing Address - Fax:805-481-8045
Practice Address - Street 1:901 OAK PARK BLVD
Practice Address - Street 2:SUITE 102
Practice Address - City:PISMO BEACH
Practice Address - State:CA
Practice Address - Zip Code:93449-3408
Practice Address - Country:US
Practice Address - Phone:805-481-8272
Practice Address - Fax:805-481-8045
Is Sole Proprietor?:No
Enumeration Date:2013-08-19
Last Update Date:2013-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT40414225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist