Provider Demographics
NPI:1922856087
Name:MANSFIELD, BRYCE WAYNE (PT, DPT)
Entity type:Individual
Prefix:
First Name:BRYCE
Middle Name:WAYNE
Last Name:MANSFIELD
Suffix:
Gender:M
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 1:100 WHEATFIELD DR STE 1
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:PA
Mailing Address - Zip Code:18337-7699
Mailing Address - Country:US
Mailing Address - Phone:570-296-5911
Mailing Address - Fax:
Practice Address - Street 1:100 WHEATFIELD DR STE 1
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:PA
Practice Address - Zip Code:18337-7699
Practice Address - Country:US
Practice Address - Phone:570-296-5911
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-13
Last Update Date:2024-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT032239225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist