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General NPI Number Information
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NPI Number | 1932252855
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Entity Type | Individual
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Provider Name | OLFEA D. MANGLE PT
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Gender | Female
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Dates
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Enumeration Date | 01/22/2007
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Last Update Date | 03/11/2008
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Provider Practice Location Address
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Address Line | 700 N BROAD ST STE 102
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City | ELIZABETH
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State | NJ
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Zip | 07208-2310
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Country | US
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Telephone | 908-354-1511
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Fax | 908-659-9229
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Provider Business Mailing Address
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Address Line | 18 RAYMOND TER ELIZABETH
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City | ELIZABETH
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State | NJ
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Zip | 07208-1710
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Country | US
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Telephone | 908-354-3359
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Fax | 908-659-9229
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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 | 40QA00504100
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License Number State | NJ
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