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General NPI Number Information
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NPI Number | 1710290150
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Entity Type | Organization
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Legal Business Name | GAITWAY PHYSICAL THERAPY PC
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Dates
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Enumeration Date | 07/14/2010
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Last Update Date | 10/03/2013
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Provider Practice Location Address
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Address Line | 6 ARCADIA LN
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City | HICKSVILLE
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State | NY
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Zip | 11801-4437
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Country | US
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Telephone | 516-623-4769
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Fax |
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Provider Business Mailing Address
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Address Line | 35 EARL DR
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City | MERRICK
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State | NY
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Zip | 11566-1708
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Country | US
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Telephone | 516-623-4769
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MR. TIMOTHY S MANGANO
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Credential | M.P.T.
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Telephone | 516-659-8252
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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 | 025236-1
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License Number State | NY
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