Provider Demographics
NPI:1518572700
Name:GIAMANCO, MICHAEL SANTO (PT, DPT)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:SANTO
Last Name:GIAMANCO
Suffix:
Gender:M
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 1:100 BLUE MOON XING STE 112
Mailing Address - Street 2:
Mailing Address - City:POOLER
Mailing Address - State:GA
Mailing Address - Zip Code:31322-9810
Mailing Address - Country:US
Mailing Address - Phone:912-450-9600
Mailing Address - Fax:912-450-9605
Practice Address - Street 1:100 BLUE MOON XING STE 112
Practice Address - Street 2:
Practice Address - City:POOLER
Practice Address - State:GA
Practice Address - Zip Code:31322-9810
Practice Address - Country:US
Practice Address - Phone:912-450-9600
Practice Address - Fax:912-450-9605
Is Sole Proprietor?:No
Enumeration Date:2020-09-14
Last Update Date:2022-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT014949225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist