| Doctor Name: | MR. EMMANUEL REQUENA |
| NPI Number: | 1861893745 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | |
| License Number: | 06004053A |
| Business Practice Address: | 20 John Kissinger Dr Wabash, IN - 469921648 |
| Business Phone Number: | 2602740868 |
| Business Fax Number: | |
| Mailing Address: | 9219 Barbara Ln, FORT WAYNE |
| State: | IN |
| Postal Code: | 468044702 |
| Phone Number: | 2605791748 |
| Fax Number: | |
| NPI Enumeration Date: | 09/10/2014 |
| NPI Last Update Date: | 09/10/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 225100000X |
| License Number: | 06004053A |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | IN |
| Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Taxonomy Classification: | Physical Therapist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | (1) Physical therapists are health care professionals who evaluate and treat people with health problems resulting from injury or disease. PT |