Provider Demographics
NPI:1790785483
Name:MANDEL, LAURIE JOAN (PT)
Entity Type:Individual
Prefix:
First Name:LAURIE
Middle Name:JOAN
Last Name:MANDEL
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:717 STATE ST
Mailing Address - Street 2:SUITE 16, LL
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16501-1341
Mailing Address - Country:US
Mailing Address - Phone:814-480-7100
Mailing Address - Fax:814-480-7604
Practice Address - Street 1:2101 NAGLE RD
Practice Address - Street 2:ATTN TRAC REHAB EAST
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16510-2189
Practice Address - Country:US
Practice Address - Phone:814-877-7078
Practice Address - Fax:814-899-5484
Is Sole Proprietor?:No
Enumeration Date:2005-07-26
Last Update Date:2008-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT006400L225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0016911470011Medicaid
PA274486OtherBLUE SHIELD
PAP00111381OtherRR MEDICARE
NY00025348902OtherUNIVERA
PA3110693OtherAETNA
PAP00111381OtherRR MEDICARE
PA3110693OtherAETNA