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NPI Code Detail

MEDICARE: JOHN ANTHONY MANDACINA II DPT

MEDICARE: JOHN ANTHONY MANDACINA II DPT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225100000XPhysical Therapist

General Provider Information

NPI Number : 1205002003
Entity Type Code : Individual
Provider Name (Legal Business Name) : JOHN ANTHONY MANDACINA II DPT
Provider Business Mailing Address
First Line : 2100 SWIFT AVE
Second Line :
City : KANSAS CITY
State : MO
Zip : 64116-3426
Country : US
Telephone Number : 816-474-8877
Fax Number :
Provider Business Practice Location Address
First Line : 2100 SWIFT AVE
Second Line :
City : KANSAS CITY
State : MO
Zip : 64116-3426
Country : US
Telephone Number : 816-474-8877
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/02/2008
Last Update Date : 05/02/2008

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