Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 021841-1 | NY |
N | 2251S0007X | Physical Therapist - Sports | 021841-1 | NY |
N | 2251X0800X | Physical Therapist - Orthopedic | 021841-1 | NY |
NPI | 1437102266 |
---|---|
Provider Name | Mrs. Deborah Ann Mangan |
First Address | New York, NY 10028-2167 |
Second Address | Hartsdale, NY 10530-2319 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/05/2006 |
Last Update Date | 23/01/2012 |