Provider Demographics
NPI:1982581526
Name:SULAPAT, MYNN GLAIZA L (PTA)
Entity type:Individual
Prefix:
First Name:MYNN GLAIZA
Middle Name:L
Last Name:SULAPAT
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:585 SATURN BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92154-4721
Mailing Address - Country:US
Mailing Address - Phone:619-591-1190
Mailing Address - Fax:
Practice Address - Street 1:585 SATURN BLVD STE A
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92154-4721
Practice Address - Country:US
Practice Address - Phone:619-591-1190
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-18
Last Update Date:2025-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA53767225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant