Provider Demographics
NPI:1104225549
Name:MANGIARELLI REHABILITATION, LLC
Entity type:Organization
Organization Name:MANGIARELLI REHABILITATION, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:PAULA
Authorized Official - Middle Name:KAY
Authorized Official - Last Name:MANGIARELLI
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:330-393-0079
Mailing Address - Street 1:8935 E MARKET ST
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:OH
Mailing Address - Zip Code:44484-2353
Mailing Address - Country:US
Mailing Address - Phone:330-393-0079
Mailing Address - Fax:330-393-0005
Practice Address - Street 1:8935 E MARKET ST
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:OH
Practice Address - Zip Code:44484-2353
Practice Address - Country:US
Practice Address - Phone:330-393-0079
Practice Address - Fax:330-393-0005
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-21
Last Update Date:2014-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH015034261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy