Provider Demographics
NPI:1841513207
Name:MANCINI, MARYANN (DPT)
Entity type:Individual
Prefix:MRS
First Name:MARYANN
Middle Name:
Last Name:MANCINI
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:MISS
Other - First Name:MARYANN
Other - Middle Name:
Other - Last Name:PESIC
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:125 LOOP RD
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:CT
Mailing Address - Zip Code:06795-1561
Mailing Address - Country:US
Mailing Address - Phone:609-618-1800
Mailing Address - Fax:
Practice Address - Street 1:465 WOLCOTT RD
Practice Address - Street 2:ADVANCED PHYSICAL THERAPY
Practice Address - City:WOLCOTT
Practice Address - State:CT
Practice Address - Zip Code:06716-2613
Practice Address - Country:US
Practice Address - Phone:203-879-0107
Practice Address - Fax:203-879-0206
Is Sole Proprietor?:No
Enumeration Date:2010-03-12
Last Update Date:2016-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT008923225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT008923OtherSTATE LICENSE