Provider Demographics
NPI:1346855012
Name:MANKOWSKI, ROBERT S (BOCO C52365)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:S
Last Name:MANKOWSKI
Suffix:
Gender:M
Credentials:BOCO C52365
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2760 BAREFOOT LN
Mailing Address - Street 2:
Mailing Address - City:WINTERVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28590-9070
Mailing Address - Country:US
Mailing Address - Phone:252-531-2266
Mailing Address - Fax:
Practice Address - Street 1:2090 W ARLINGTON BLVD
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27834-5727
Practice Address - Country:US
Practice Address - Phone:252-321-1154
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-10
Last Update Date:2020-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
C52365222Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist