Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2251S0007X | Physical Therapist - Sports | 015434 | NY |
N | 2251X0800X | Physical Therapist - Orthopedic | 015434 | NY |
NPI | 1205856036 |
---|---|
Provider Name | Stephanie Anne Mannarino |
First Address | Hawthorne, NY 10532 |
Second Address | Hawthorne, NY 10532 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/07/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
015434 | LICENSE (01) | NY |