Provider Demographics
NPI:1235650292
Name:MANGIALARDI, JOHN F (DPT)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:F
Last Name:MANGIALARDI
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7065 AIRWAYS BLVD STE 110
Mailing Address - Street 2:
Mailing Address - City:SOUTHAVEN
Mailing Address - State:MS
Mailing Address - Zip Code:38671-5874
Mailing Address - Country:US
Mailing Address - Phone:662-349-8997
Mailing Address - Fax:662-349-8987
Practice Address - Street 1:7065 AIRWAYS BLVD STE 110
Practice Address - Street 2:
Practice Address - City:SOUTHAVEN
Practice Address - State:MS
Practice Address - Zip Code:38671-5874
Practice Address - Country:US
Practice Address - Phone:662-349-8997
Practice Address - Fax:662-349-8987
Is Sole Proprietor?:No
Enumeration Date:2017-06-29
Last Update Date:2017-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSPT6169225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MSPT6169OtherPT LICENSE