Provider Demographics
NPI:1386836054
Name:MANTZARIS, JANINE RUNIONS (PT)
Entity Type:Individual
Prefix:MRS
First Name:JANINE
Middle Name:RUNIONS
Last Name:MANTZARIS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:97 WINTERS ST
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10464
Mailing Address - Country:US
Mailing Address - Phone:718-885-1079
Mailing Address - Fax:718-885-1089
Practice Address - Street 1:464 CITY ISLAND AVE.
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10464
Practice Address - Country:US
Practice Address - Phone:718-885-1079
Practice Address - Fax:718-885-1089
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-15
Last Update Date:2017-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017086225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
QP4161Medicare UPIN