Provider Demographics
NPI:1639311806
Name:MANDAGLIO, LAURA L (L P T)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:L
Last Name:MANDAGLIO
Suffix:
Gender:F
Credentials:L P T
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:269 ROUTE 31
Mailing Address - Street 2:SUITE 1
Mailing Address - City:WASHINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07882
Mailing Address - Country:US
Mailing Address - Phone:908-835-8533
Mailing Address - Fax:908-835-8522
Practice Address - Street 1:269 ROUTE 31
Practice Address - Street 2:SUITE 1
Practice Address - City:WASHINGTON
Practice Address - State:NJ
Practice Address - Zip Code:07882
Practice Address - Country:US
Practice Address - Phone:908-835-8533
Practice Address - Fax:908-835-8522
Is Sole Proprietor?:No
Enumeration Date:2009-04-02
Last Update Date:2009-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00209100225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist