Provider Demographics
NPI:1710966890
Name:MANCINO, JOSEPH F JR (PT)
Entity Type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:F
Last Name:MANCINO
Suffix:JR
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1615 NORTH MAIN STREET EXT
Mailing Address - Street 2:
Mailing Address - City:BUTLER
Mailing Address - State:PA
Mailing Address - Zip Code:16001-1512
Mailing Address - Country:US
Mailing Address - Phone:724-285-5546
Mailing Address - Fax:724-285-3883
Practice Address - Street 1:1615 NORTH MAIN STREET EXT
Practice Address - Street 2:
Practice Address - City:BUTLER
Practice Address - State:PA
Practice Address - Zip Code:16001-1512
Practice Address - Country:US
Practice Address - Phone:724-285-5546
Practice Address - Fax:724-285-3883
Is Sole Proprietor?:No
Enumeration Date:2006-01-17
Last Update Date:2012-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT007139L225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1008484120002Medicaid
PA1008484120002Medicaid
088890Medicare PIN