Provider Demographics
NPI:1962631416
Name:MANNIKKO, ANDREW J (DPT)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:J
Last Name:MANNIKKO
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8300 FALLS OF NEUSE RD.
Mailing Address - Street 2:SUITE 104
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27615-3450
Mailing Address - Country:US
Mailing Address - Phone:919-846-9668
Mailing Address - Fax:919-846-9663
Practice Address - Street 1:8300 FALLS OF NEUSE RD.
Practice Address - Street 2:SUITE 104
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27615-3450
Practice Address - Country:US
Practice Address - Phone:919-846-9668
Practice Address - Fax:919-846-9663
Is Sole Proprietor?:No
Enumeration Date:2009-07-06
Last Update Date:2011-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC11754225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist