Provider Demographics
NPI:1639359540
Name:PINNACLE PERFORMANCE PT PLLC
Entity Type:Organization
Organization Name:PINNACLE PERFORMANCE PT PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICK
Authorized Official - Middle Name:
Authorized Official - Last Name:MANNELLO
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:914-356-0484
Mailing Address - Street 1:428 CENTRAL PARK AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:SCARSDALE
Mailing Address - State:NY
Mailing Address - Zip Code:10583-1017
Mailing Address - Country:US
Mailing Address - Phone:914-356-0484
Mailing Address - Fax:914-709-4002
Practice Address - Street 1:428 CENTRAL PARK AVE
Practice Address - Street 2:SUITE B
Practice Address - City:SCARSDALE
Practice Address - State:NY
Practice Address - Zip Code:10583-1017
Practice Address - Country:US
Practice Address - Phone:914-356-0484
Practice Address - Fax:914-709-4002
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-07
Last Update Date:2016-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0287051225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYWZQQZ1Medicare PIN