Provider Demographics
NPI:1285677344
Name:MANDANAS, VICTOR (PT)
Entity Type:Individual
Prefix:
First Name:VICTOR
Middle Name:
Last Name:MANDANAS
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 1:2054 NAKISKA CT
Mailing Address - Street 2:
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08755-1019
Mailing Address - Country:US
Mailing Address - Phone:732-736-1045
Mailing Address - Fax:
Practice Address - Street 1:2054 NAKISKA CT
Practice Address - Street 2:
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08755-1019
Practice Address - Country:US
Practice Address - Phone:732-736-1045
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-14
Last Update Date:2014-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01115100225100000X
NY25903225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist