Provider Demographics
NPI:1871637900
Name:MANGANO, TIMOTHY S (MPT)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:S
Last Name:MANGANO
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 ARCADIA LANE
Mailing Address - Street 2:
Mailing Address - City:HICKSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11801-4437
Mailing Address - Country:US
Mailing Address - Phone:516-659-8252
Mailing Address - Fax:516-771-0621
Practice Address - Street 1:6 ARCADIA LANE
Practice Address - Street 2:
Practice Address - City:HICKSVILLE
Practice Address - State:NY
Practice Address - Zip Code:11801-4437
Practice Address - Country:US
Practice Address - Phone:516-659-8252
Practice Address - Fax:516-771-0621
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-20
Last Update Date:2008-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY025236-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist