Provider Demographics
NPI:1679828917
Name:MANCINO, SAMANTHA ALYSE (PT,DPT)
Entity Type:Individual
Prefix:MS
First Name:SAMANTHA
Middle Name:ALYSE
Last Name:MANCINO
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 1:600 W NORTH BLVD
Mailing Address - Street 2:SUITE D
Mailing Address - City:LEESBURG
Mailing Address - State:FL
Mailing Address - Zip Code:34748-5063
Mailing Address - Country:US
Mailing Address - Phone:352-728-6636
Mailing Address - Fax:352-728-1322
Practice Address - Street 1:600 W NORTH BLVD
Practice Address - Street 2:SUITE D
Practice Address - City:LEESBURG
Practice Address - State:FL
Practice Address - Zip Code:34748-5063
Practice Address - Country:US
Practice Address - Phone:352-728-6636
Practice Address - Fax:352-728-1322
Is Sole Proprietor?:No
Enumeration Date:2012-07-23
Last Update Date:2016-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT31065225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist