Provider Demographics
NPI:1194863621
Name:MANZELLA, DAVID (PT)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:MANZELLA
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 1:4 CENTRE DR STE G
Mailing Address - Street 2:
Mailing Address - City:ORCHARD PARK
Mailing Address - State:NY
Mailing Address - Zip Code:14127-4117
Mailing Address - Country:US
Mailing Address - Phone:716-662-2922
Mailing Address - Fax:716-662-3828
Practice Address - Street 1:4 CENTRE DR STE G
Practice Address - Street 2:
Practice Address - City:ORCHARD PARK
Practice Address - State:NY
Practice Address - Zip Code:14127-4117
Practice Address - Country:US
Practice Address - Phone:716-662-2922
Practice Address - Fax:716-662-3828
Is Sole Proprietor?:No
Enumeration Date:2007-02-05
Last Update Date:2022-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY12209225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYBB7330Medicare ID - Type UnspecifiedMEDICARE PROV NUMBER