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NPI Code Detail

MEDICARE: MRS. MELINDA MARIE MANGANELLO PT, DPT

MEDICARE: MRS. MELINDA MARIE MANGANELLO PT, 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 Therapist17337MA
2225100000XPhysical Therapist40QA01291000NJ

General Provider Information

NPI Number : 1912950346
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. MELINDA MARIE MANGANELLO PT, DPT
Provider Business Mailing Address
First Line : 254B MOUNTAIN AVE, STE 201
Second Line : NJ SPORT & SPINE
City : HACKETTSTOWN
State : NJ
Zip : 07840
Country : US
Telephone Number : 908-684-5800
Fax Number : 908-684-5606
Provider Business Practice Location Address
First Line : 655 MAIN ST S
Second Line :
City : SOUTHBURY
State : CT
Zip : 06488-4220
Country : US
Telephone Number : 877-407-3422
Fax Number : 877-407-4329
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/18/2006
Last Update Date : 04/29/2025

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