Provider Demographics
NPI:1932252855
Name:MANGLE, OLFEA D (PT)
Entity Type:Individual
Prefix:MRS
First Name:OLFEA
Middle Name:D
Last Name:MANGLE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:18 RAYMOND TER
Mailing Address - Street 2:ELIZABETH
Mailing Address - City:ELIZABETH
Mailing Address - State:NJ
Mailing Address - Zip Code:07208-1710
Mailing Address - Country:US
Mailing Address - Phone:908-354-3359
Mailing Address - Fax:908-659-9229
Practice Address - Street 1:700 N BROAD ST STE 102
Practice Address - Street 2:
Practice Address - City:ELIZABETH
Practice Address - State:NJ
Practice Address - Zip Code:07208-2310
Practice Address - Country:US
Practice Address - Phone:908-354-1511
Practice Address - Fax:908-659-9229
Is Sole Proprietor?:No
Enumeration Date:2007-01-22
Last Update Date:2008-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00504100225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ44902OtherCIGNA-ORTHONET
NJQ23Q61OtherEMPIRE BC BS
NJ1591748OtherFOCUS
NJP3440262OtherOXFORD HEALTH PLANS
NJ687933OtherACN GROUP
NJ0000-225-0032-04OtherUNITED HEALTHCARE
NJ3K4126OtherHEALTHNET
NJQ23Q61OtherEMPIRE BC BS
NJP3440262OtherOXFORD HEALTH PLANS