Provider Demographics
NPI:1326589615
Name:SANDRA MANNINO PT PLLC
Entity Type:Organization
Organization Name:SANDRA MANNINO PT PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:MANNINO
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:917-468-7528
Mailing Address - Street 1:6 GALLEON LN
Mailing Address - Street 2:
Mailing Address - City:EAST SETAUKET
Mailing Address - State:NY
Mailing Address - Zip Code:11733-1816
Mailing Address - Country:US
Mailing Address - Phone:917-468-7528
Mailing Address - Fax:
Practice Address - Street 1:6 GALLEON LN
Practice Address - Street 2:
Practice Address - City:EAST SETAUKET
Practice Address - State:NY
Practice Address - Zip Code:11733-1816
Practice Address - Country:US
Practice Address - Phone:917-468-7528
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-20
Last Update Date:2017-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY014207-1252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency