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General NPI Number Information
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NPI Number | 1316031222
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Entity Type | Organization
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Legal Business Name | J.Z. MANN PEDIATRIC THERAPY, INC.
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Dates
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Enumeration Date | 10/03/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 410 NEW BRIDGE ST SUITE 10-A
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City | JACKSONVILLE
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State | NC
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Zip | 28540-4739
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Country | US
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Telephone | 910-347-2212
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Fax | 910-347-6003
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Provider Business Mailing Address
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Address Line | 410 NEW BRIDGE ST SUITE 10-A
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City | JACKSONVILLE
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State | NC
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Zip | 28540-4739
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Country | US
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Telephone | 910-347-2212
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Fax | 910-347-6003
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MR. HORACE MANN
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Credential |
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Telephone | 910-347-2212
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 1951
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License Number State | NC
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