Provider Demographics
NPI:1235649286
Name:MANCINI, MARIE (LAT, ATC)
Entity Type:Individual
Prefix:
First Name:MARIE
Middle Name:
Last Name:MANCINI
Suffix:
Gender:F
Credentials:LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 COLLEGE AVE
Mailing Address - Street 2:
Mailing Address - City:SWARTHMORE
Mailing Address - State:PA
Mailing Address - Zip Code:19081-1306
Mailing Address - Country:US
Mailing Address - Phone:610-328-8223
Mailing Address - Fax:
Practice Address - Street 1:500 COLLEGE AVE # 1219
Practice Address - Street 2:
Practice Address - City:SWARTHMORE
Practice Address - State:PA
Practice Address - Zip Code:19081-1306
Practice Address - Country:US
Practice Address - Phone:610-328-8223
Practice Address - Fax:610-328-7798
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-04
Last Update Date:2017-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PART000272A2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer