MEDICARE: PATRICIA FANNYA MANCHAK P.T.

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	PT009427L	PA
2	225100000X	Physical Therapist	J1-0001028	DE

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
6	P00692875	OTHER	DE	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0479677000	OTHER	DE	IBC
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	1487610366	OTHER	DE	DPCI
4	254215	OTHER		UNISON
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
7	5916630	OTHER		AETNA

General Provider Information

NPI Number	:	1487610366
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PATRICIA FANNYA MANCHAK P.T.

Provider Business Mailing Address
First Line	:	1377 MOTOR PKWY STE 307
Second Line	:
City	:	ISLANDIA
State	:	NY
Zip	:	11749-5258
Country	:	US
Telephone Number	:	631-580-5200
Fax Number	:	631-760-8306

Provider Business Practice Location Address
First Line	:	2714 PHILADELPHIA PIKE
Second Line	:
City	:	CLAYMONT
State	:	DE
Zip	:	19703-2568
Country	:	US
Telephone Number	:	302-408-7310
Fax Number	:	302-416-4817

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

Provider Enumeration Date	:	04/21/2006
Last Update Date	:	08/21/2020

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