Provider Demographics
NPI:1285089870
Name:MANGINI, JAMIE
Entity type:Individual
Prefix:
First Name:JAMIE
Middle Name:
Last Name:MANGINI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 S MAIN ST
Mailing Address - Street 2:STE 220
Mailing Address - City:JAMESTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:14701-6626
Mailing Address - Country:US
Mailing Address - Phone:716-488-2322
Mailing Address - Fax:716-488-2574
Practice Address - Street 1:987 BROOKVILLE ST
Practice Address - Street 2:
Practice Address - City:FAIRMOUNT CITY
Practice Address - State:PA
Practice Address - Zip Code:16224-0046
Practice Address - Country:US
Practice Address - Phone:814-275-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-02
Last Update Date:2017-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT025024225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA65OtherMEDICARE B SPECIALTY CODE