Provider Demographics
NPI:1508347774
Name:MANGINI, CAROL M (PT, DPT)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:M
Last Name:MANGINI
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:538 LIPPINCOTT DR BLDG E
Mailing Address - Street 2:
Mailing Address - City:MARLTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08053-4806
Mailing Address - Country:US
Mailing Address - Phone:856-489-0505
Mailing Address - Fax:856-489-0435
Practice Address - Street 1:538 LIPPINCOTT DR BLDG E
Practice Address - Street 2:
Practice Address - City:MARLTON
Practice Address - State:NJ
Practice Address - Zip Code:08053-4806
Practice Address - Country:US
Practice Address - Phone:856-489-0505
Practice Address - Fax:856-489-0435
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-27
Last Update Date:2018-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00216500225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ40QA00216500OtherLICENSE