Provider Demographics
NPI:1952490906
Name:MANNISIO, BERNARD LOUIS (PT)
Entity Type:Individual
Prefix:
First Name:BERNARD
Middle Name:LOUIS
Last Name:MANNISIO
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:BERNARD
Other - Middle Name:
Other - Last Name:MARCHISIO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:5445 DTC PKWY STE 1130
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD VILLAGE
Mailing Address - State:CO
Mailing Address - Zip Code:80111-3038
Mailing Address - Country:US
Mailing Address - Phone:720-749-5599
Mailing Address - Fax:720-925-5897
Practice Address - Street 1:5920 S ESTES ST STE 220
Practice Address - Street 2:
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80123-8619
Practice Address - Country:US
Practice Address - Phone:303-978-0734
Practice Address - Fax:720-925-5897
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2024-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305205087225100000X
DCPT870974225100000X
COPTL-9509225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist