Provider Demographics
NPI:1831558139
Name:MANSFIELD, DEREK (PT)
Entity type:Individual
Prefix:
First Name:DEREK
Middle Name:
Last Name:MANSFIELD
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 COLONIAL AVE
Mailing Address - Street 2:
Mailing Address - City:DOBBS FERRY
Mailing Address - State:NY
Mailing Address - Zip Code:10522-2902
Mailing Address - Country:US
Mailing Address - Phone:914-222-0876
Mailing Address - Fax:
Practice Address - Street 1:145 PALISADE ST STE 217
Practice Address - Street 2:
Practice Address - City:DOBBS FERRY
Practice Address - State:NY
Practice Address - Zip Code:10522-1617
Practice Address - Country:US
Practice Address - Phone:914-222-0876
Practice Address - Fax:347-713-7748
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-15
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY018-9342251X0800X
NY0189342251S0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSportsGroup - Multi-Specialty
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Multi-Specialty