Provider Demographics
NPI:1215772959
Name:MANGEN, ELIZABETH (ATS)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:MANGEN
Suffix:
Gender:F
Credentials:ATS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1107 GERALD AVE
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59801-4235
Mailing Address - Country:US
Mailing Address - Phone:208-530-3215
Mailing Address - Fax:
Practice Address - Street 1:1107 GERALD AVE
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59801-4235
Practice Address - Country:US
Practice Address - Phone:208-530-3215
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-25
Last Update Date:2024-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer