Provider Demographics
NPI:1194191023
Name:MANCUSO, ANDREW M (PT)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:M
Last Name:MANCUSO
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2300 TRENTON RD
Mailing Address - Street 2:
Mailing Address - City:LEVITTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19056-1423
Mailing Address - Country:US
Mailing Address - Phone:215-943-3300
Mailing Address - Fax:215-943-6330
Practice Address - Street 1:2300 TRENTON RD
Practice Address - Street 2:
Practice Address - City:LEVITTOWN
Practice Address - State:PA
Practice Address - Zip Code:19056-1423
Practice Address - Country:US
Practice Address - Phone:215-943-3300
Practice Address - Fax:215-943-6330
Is Sole Proprietor?:No
Enumeration Date:2015-08-14
Last Update Date:2015-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT024591225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist