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General NPI Number Information
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NPI Number | 1568726800
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Entity Type | Individual
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Provider Name | JARED CHARLES MANNELLO PT, DPT, OCS
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Gender | Male
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Dates
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Enumeration Date | 07/02/2012
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Last Update Date | 07/30/2024
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Provider Practice Location Address
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Address Line | 450 BAY AVE STE 3
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City | SOMERS POINT
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State | NJ
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Zip | 08244-2656
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Country | US
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Telephone | 609-350-6680
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Fax |
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Provider Business Mailing Address
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Address Line | 23 N DELSEA DR UNIT B
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City | CLAYTON
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State | NJ
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Zip | 08312-1637
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Country | US
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Telephone | 856-423-7000
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Fax | 856-423-0823
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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 | 40QA01314800
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License Number State | NJ
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