Healthcare Provider Details

I. General information

NPI: 1598610610
Provider Name (Legal Business Name): JOHN J MANDILE
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/03/2026
Last Update Date: 03/03/2026
Certification Date: 03/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5360 LINTON BLVD
DELRAY BEACH FL
33484-6514
US

IV. Provider business mailing address

5360 LINTON BLVD
DELRAY BEACH FL
33484-6514
US

V. Phone/Fax

Practice location:
  • Phone: 561-495-3636
  • Fax: 561-495-2523
Mailing address:
  • Phone: 561-495-3636
  • Fax: 561-495-2523

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0019X
TaxonomyPhysical Rehabilitation Occupational Therapist
License NumberOT11569
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: