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General NPI Number Information
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NPI Number | 1518118611
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Entity Type | Individual
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Provider Name | STEPHANIE MICHELE MANNIKKO DPT, MCMT
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Gender | Female
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Dates
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Enumeration Date | 10/07/2008
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Last Update Date | 11/25/2014
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Provider Practice Location Address
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Address Line | 3325 HOLLYWOOD BLVD SUITE 200
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City | HOLLYWOOD
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State | FL
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Zip | 33021-6999
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Country | US
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Telephone | 954-986-2299
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Fax |
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Provider Business Mailing Address
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Address Line | 400 SE 4TH CT
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City | POMPANO BEACH
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State | FL
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Zip | 33060-8013
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Country | US
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Telephone | 732-406-0312
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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 | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT 25244
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License Number State | FL
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