=====================================================
General NPI Number Information
=====================================================
NPI Number | 1871919761
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SATHISH KUMAR MANI
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/15/2014
-----------------------------------------------------
Last Update Date | 11/05/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 20 MANOR DR
-----------------------------------------------------
City | OSWEGO
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 13126-6495
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 315-349-5300
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 120 ANDERSON AVE
-----------------------------------------------------
City | BOWLING GREEN
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22427-9401
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 909-907-2821
-----------------------------------------------------
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 |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | 034552
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------