| Doctor Name: | SUSEJED ANN MANANQUIL |
| NPI Number: | 1053643031 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | |
| License Number: | 004471 |
| Business Practice Address: | 2700 1st Ave S Fort Dodge, IA - 505014300 |
| Business Phone Number: | 5159556922 |
| Business Fax Number: | |
| Mailing Address: | 3132 16th Ave N, Apt 3 FORT DODGE |
| State: | IA |
| Postal Code: | 505018046 |
| Phone Number: | |
| Fax Number: | |
| NPI Enumeration Date: | 02/02/2010 |
| NPI Last Update Date: | 02/02/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 2251X0800X |
| License Number: | 004471 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | IA |
| Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Taxonomy Classification: | Physical Therapist |
| Taxonomy Specialization: | Orthopedic |
| Taxonomy Definition: | |