Provider Demographics
NPI:1386789063
Name:MANCUSO, JANINE P (PT)
Entity type:Individual
Prefix:MRS
First Name:JANINE
Middle Name:P
Last Name:MANCUSO
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:JANINE
Other - Middle Name:P
Other - Last Name:THERRIEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3701 NW CARY PARKWAY
Mailing Address - Street 2:SUITE 301
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27513
Mailing Address - Country:US
Mailing Address - Phone:919-388-0111
Mailing Address - Fax:919-228-3333
Practice Address - Street 1:3701 NW CARY PARKWAY
Practice Address - Street 2:SUITE 301
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27513
Practice Address - Country:US
Practice Address - Phone:919-388-0111
Practice Address - Fax:919-228-3333
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9708225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7194752OtherAETNA
NC079W4OtherBLUE CROSS BLUE SHIELD
NC079W4OtherBLUE CROSS BLUE SHIELD