Healthcare Provider Details

I. General information

NPI: 1972611747
Provider Name (Legal Business Name): DANA E. MANDEL PT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/29/2006
Last Update Date: 02/08/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8842 STATE ROUTE 90
KING FERRY NY
13081
US

IV. Provider business mailing address

8842 STATE ROUTE 90
KING FERRY NY
13081
US

V. Phone/Fax

Practice location:
  • Phone: 315-364-7570
  • Fax: 315-364-8016
Mailing address:
  • Phone: 315-364-7570
  • Fax: 315-364-8016

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: MR. DANA E. MANDEL
Title or Position: PHYSICAL THERAPIST / OWNER
Credential: PT, PCS
Phone: 315-364-7570