Provider Demographics
NPI:1255394474
Name:MANGINE, ROBERT (MED, PT, ATC)
Entity type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:
Last Name:MANGINE
Suffix:
Gender:M
Credentials:MED, PT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:912 CAITLIN DR
Mailing Address - Street 2:
Mailing Address - City:UNION
Mailing Address - State:KY
Mailing Address - Zip Code:41091-8009
Mailing Address - Country:US
Mailing Address - Phone:859-802-2524
Mailing Address - Fax:
Practice Address - Street 1:2920 SCIOTO HALL, ROOM 108
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45267-0001
Practice Address - Country:US
Practice Address - Phone:513-556-3178
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT3306225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist