MEDICARE: JANINE MANTZARIS PHYSICAL THERAPY PC

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	261QP2000X	Physical Therapy Clinic/Center	017086	NY

General Provider Information

NPI Number	:	1104061290
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JANINE MANTZARIS PHYSICAL THERAPY PC

Provider Business Mailing Address
First Line	:	97 WINTERS ST
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10464-1519
Country	:	US
Telephone Number	:	917-577-1752
Fax Number	:	718-885-1191

Provider Business Practice Location Address
First Line	:	190 FORDHAM ST
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10464-1422
Country	:	US
Telephone Number	:	917-577-1752
Fax Number	:	718-885-1191

Authorized Official
Title or Position	:	OWNER/PHERAPIST
Name	:	MRS. JANINE RUNIONS MANTZARIS
Credential	:	PHYSICAL THERAPIST
Telephone Number	:	917-577-1752

Provider Enumeration Date	:	12/04/2008
Last Update Date	:	12/04/2008

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