MEDICARE: MR. MATTHEW MICHAEL MANCINI 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	PT. 009780	OH

General Provider Information

NPI Number	:	1649396730
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MATTHEW MICHAEL MANCINI P.T.

Provider Business Mailing Address
First Line	:	38089 PELICAN LAKE DR
Second Line	:
City	:	NORTH RIDGEVILLE
State	:	OH
Zip	:	44039-5136
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4511 ROCKSIDE RD
Second Line	:	SUITE 330
City	:	INDEPENDENCE
State	:	OH
Zip	:	44131-2199
Country	:	US
Telephone Number	:	216-901-0400
Fax Number	:	216-901-0401

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

Provider Enumeration Date	:	03/21/2007
Last Update Date	:	07/08/2007

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