Healthcare Provider Details

I. General information

NPI: 1346172434
Provider Name (Legal Business Name): EDWARD MANNONE DPT, PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2026
Last Update Date: 06/02/2026
Certification Date: 06/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

159 ISLIP AVE
ISLIP NY
11751-3210
US

IV. Provider business mailing address

191 PATCHOGUE YAPHANK RD
EAST PATCHOGUE NY
11772-4899
US

V. Phone/Fax

Practice location:
  • Phone: 631-775-0971
  • Fax:
Mailing address:
  • Phone: 631-775-0971
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number055898
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: