Provider Demographics
NPI:1356884910
Name:MANSFIELD, NICOLE MARIE (PTA)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:MARIE
Last Name:MANSFIELD
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:549 EDGEWOOD RD
Mailing Address - Street 2:
Mailing Address - City:BEAVER FALLS
Mailing Address - State:PA
Mailing Address - Zip Code:15010-4919
Mailing Address - Country:US
Mailing Address - Phone:724-650-3577
Mailing Address - Fax:
Practice Address - Street 1:549 EDGEWOOD RD
Practice Address - Street 2:
Practice Address - City:BEAVER FALLS
Practice Address - State:PA
Practice Address - Zip Code:15010-4919
Practice Address - Country:US
Practice Address - Phone:724-650-3577
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-29
Last Update Date:2016-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PATE011009261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy