MEDICARE: MR. JERROLD MANN PT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	0016951	NY

General Provider Information

NPI Number	:	1093740003
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JERROLD MANN PT

Provider Business Mailing Address
First Line	:	2735 HENRY HUDSON PKWY
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10463
Country	:	US
Telephone Number	:	718-884-0444
Fax Number	:	718-549-0145

Provider Business Practice Location Address
First Line	:	2735 HENRY HUDSON PKWY
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10463-4701
Country	:	US
Telephone Number	:	718-884-0444
Fax Number	:	718-549-0145

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/11/2006
Last Update Date	:	04/14/2008

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