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General NPI Number Information
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NPI Number | 1487610366
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Entity Type | Individual
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Provider Name | PATRICIA FANNYA MANCHAK P.T.
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Gender | Female
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Dates
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Enumeration Date | 04/21/2006
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Last Update Date | 08/21/2020
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Provider Practice Location Address
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Address Line | 2714 PHILADELPHIA PIKE
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City | CLAYMONT
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State | DE
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Zip | 19703-2568
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Country | US
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Telephone | 302-408-7310
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Fax | 302-416-4817
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Provider Business Mailing Address
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Address Line | 1377 MOTOR PKWY STE 307
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City | ISLANDIA
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State | NY
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Zip | 11749-5258
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Country | US
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Telephone | 631-580-5200
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Fax | 631-760-8306
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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 | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT009427L
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | J1-0001028
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License Number State | DE
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