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General NPI Number Information
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NPI Number | 1326589615
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Entity Type | Organization
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Legal Business Name | SANDRA MANNINO PT PLLC
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Dates
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Enumeration Date | 03/20/2017
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Last Update Date | 03/20/2017
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Provider Practice Location Address
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Address Line | 6 GALLEON LN
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City | EAST SETAUKET
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State | NY
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Zip | 11733-1816
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Country | US
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Telephone | 917-468-7528
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Fax |
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Provider Business Mailing Address
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Address Line | 6 GALLEON LN
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City | EAST SETAUKET
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State | NY
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Zip | 11733-1816
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Country | US
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Telephone | 917-468-7528
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Fax |
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Authorized Official
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Title or Position | PHYSICAL THERAPIST
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Name | MS. SANDRA MANNINO
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Credential | PT
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Telephone | 917-468-7528
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 252Y00000X
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Taxonomy Name | Early Intervention Provider Agency
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License Number | 014207-1
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License Number State | NY
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