Provider Demographics
NPI:1790437119
Name:MANGANELLA, JOELLE (PT, DPT)
Entity Type:Individual
Prefix:
First Name:JOELLE
Middle Name:
Last Name:MANGANELLA
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 1:57 ROUTE 46 STE 108
Mailing Address - Street 2:
Mailing Address - City:HACKETTSTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07840-2695
Mailing Address - Country:US
Mailing Address - Phone:908-835-8533
Mailing Address - Fax:908-835-8522
Practice Address - Street 1:269 STATE ROUTE 31 S STE 1
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:NJ
Practice Address - Zip Code:07882-4086
Practice Address - Country:US
Practice Address - Phone:908-835-8533
Practice Address - Fax:908-835-8522
Is Sole Proprietor?:No
Enumeration Date:2022-01-26
Last Update Date:2024-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA02066600225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist