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General NPI Number Information
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NPI Number | 1982202487
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Entity Type | Individual
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Provider Name | ELIZABETH J MANENTO LPTA
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Gender | Female
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Dates
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Enumeration Date | 10/15/2020
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Last Update Date | 10/15/2020
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Provider Practice Location Address
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Address Line | 400 N MAIN ST
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City | BRISTOL
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State | CT
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Zip | 06010-4923
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Country | US
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Telephone | 860-584-3400
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Fax |
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Provider Business Mailing Address
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Address Line | 155 REDSTONE HILL RD APT 63
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City | BRISTOL
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State | CT
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Zip | 06010-7784
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Country | US
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Telephone | 860-866-6039
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Fax |
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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 | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 0009480
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License Number State | CT
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