=====================================================
General NPI Number Information
=====================================================
NPI Number | 1851016323
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | STEPHEN F MANKINS PT, DPT
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/07/2022
-----------------------------------------------------
Last Update Date | 12/19/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1715 MECHANICSBURG RD
-----------------------------------------------------
City | WOOSTER
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44691-2640
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 330-845-4096
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2960 WENGER RD S
-----------------------------------------------------
City | DALTON
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44618-9277
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 330-317-0821
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | PT015438
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------