Provider Demographics
NPI:1427283225
Name:MANKO, MICHAEL ALAN (PT)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:ALAN
Last Name:MANKO
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:330 NE 8TH ST
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33432-2724
Mailing Address - Country:US
Mailing Address - Phone:561-338-4751
Mailing Address - Fax:561-338-4751
Practice Address - Street 1:700 S FEDERAL HWY STE D
Practice Address - Street 2:
Practice Address - City:DEERFIELD BEACH
Practice Address - State:FL
Practice Address - Zip Code:33441-5786
Practice Address - Country:US
Practice Address - Phone:954-354-1414
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-05-22
Last Update Date:2009-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT4412225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist