Provider Demographics
NPI:1205204963
Name:MANCHALA, SWATHI K (PT)
Entity Type:Individual
Prefix:
First Name:SWATHI
Middle Name:K
Last Name:MANCHALA
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8937 BOEHM DR
Mailing Address - Street 2:
Mailing Address - City:LENEXA
Mailing Address - State:KS
Mailing Address - Zip Code:66219-2176
Mailing Address - Country:US
Mailing Address - Phone:201-899-8634
Mailing Address - Fax:
Practice Address - Street 1:605 FRANK E RODGERS BLVD N
Practice Address - Street 2:APT 2B
Practice Address - City:HARRISON
Practice Address - State:NJ
Practice Address - Zip Code:07029-2636
Practice Address - Country:US
Practice Address - Phone:201-899-8634
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-10
Last Update Date:2023-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01653000225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist