Provider Demographics
NPI:1508168907
Name:MANGIBIN, BARBRA JOANNE FLORES (PT, DPT)
Entity Type:Individual
Prefix:
First Name:BARBRA JOANNE
Middle Name:FLORES
Last Name:MANGIBIN
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:BARBRA
Other - Middle Name:
Other - Last Name:MANGIBIN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:1142 44TH DR
Mailing Address - Street 2:5
Mailing Address - City:LONG ISLAND CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11101-5157
Mailing Address - Country:US
Mailing Address - Phone:347-579-6517
Mailing Address - Fax:
Practice Address - Street 1:1142 44TH DR
Practice Address - Street 2:5
Practice Address - City:LONG ISLAND CITY
Practice Address - State:NY
Practice Address - Zip Code:11101-5157
Practice Address - Country:US
Practice Address - Phone:347-579-6517
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-11-17
Last Update Date:2013-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY030740225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist