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General NPI Number Information
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NPI Number | 1891217899
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Entity Type | Organization
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Legal Business Name | MANCINI PHYSICAL THERAPY, PC
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Dates
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Enumeration Date | 07/11/2017
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 375 COMMACK RD STE B
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City | DEER PARK
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State | NY
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Zip | 11729-5515
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Country | US
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Telephone | 516-318-8556
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Fax |
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Provider Business Mailing Address
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Address Line | 375 COMMACK RD STE B
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City | DEER PARK
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State | NY
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Zip | 11729-5515
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Country | US
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Telephone | 631-522-1955
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Fax |
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Authorized Official
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Title or Position | OWNER/PHYSICAL THERAPIST
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Name | JOHN MANCINI
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Credential | MSPT
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Telephone | 631-522-1955
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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 | 020597
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License Number State |
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