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General NPI Number Information
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NPI Number | 1194115766
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Entity Type | Individual
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Provider Name | PAIGE MANGIERO ATC LAT
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Gender | Female
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Dates
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Enumeration Date | 02/03/2015
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Last Update Date | 04/18/2022
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Provider Practice Location Address
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Address Line | 1733 W GIRARD AVE
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City | PHILADELPHIA
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State | PA
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Zip | 19130-1513
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Country | US
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Telephone | 215-978-1972
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Fax |
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Provider Business Mailing Address
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Address Line | 1719 DEWES ST
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City | GLENVIEW
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State | IL
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Zip | 60025-4301
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number |
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License Number State |
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