Provider Demographics
NPI:1073351128
Name:MANTANONA, JOHN S (PT, DPT)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:S
Last Name:MANTANONA
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9300 MEADOWFIELD CT APT L
Mailing Address - Street 2:
Mailing Address - City:GLEN ALLEN
Mailing Address - State:VA
Mailing Address - Zip Code:23060-2330
Mailing Address - Country:US
Mailing Address - Phone:509-820-8429
Mailing Address - Fax:
Practice Address - Street 1:2000 WILKES RIDGE DR
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23233-7632
Practice Address - Country:US
Practice Address - Phone:804-877-4000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-15
Last Update Date:2024-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251N0400XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistNeurology