MEDICARE: SUSAN L MANCONE PT

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
1	225100000X	Physical Therapist	PT 2095	FL

General Provider Information

NPI Number	:	1316279342
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUSAN L MANCONE PT

Provider Business Mailing Address
First Line	:	478 FORESTA TER
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33415-2614
Country	:	US
Telephone Number	:	561-682-3888
Fax Number	:	561-682-3888

Provider Business Practice Location Address
First Line	:	6749 LAS COLINAS ST
Second Line	:
City	:	LAKE WORTH
State	:	FL
Zip	:	33463-6566
Country	:	US
Telephone Number	:	561-964-1020
Fax Number	:	561-641-4455

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/01/2010
Last Update Date	:	02/01/2010

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