Provider Demographics
NPI:1053538256
Name:MANGIONE, CARL J (PT,DPT,OSC,RKC)
Entity type:Individual
Prefix:DR
First Name:CARL
Middle Name:J
Last Name:MANGIONE
Suffix:
Gender:M
Credentials:PT,DPT,OSC,RKC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1243 EASTON RD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:WARRINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:18976-3801
Mailing Address - Country:US
Mailing Address - Phone:215-343-9400
Mailing Address - Fax:215-343-4401
Practice Address - Street 1:1243 EASTON RD
Practice Address - Street 2:SUITE 104
Practice Address - City:WARRINGTON
Practice Address - State:PA
Practice Address - Zip Code:18976-3801
Practice Address - Country:US
Practice Address - Phone:215-343-9400
Practice Address - Fax:215-343-4401
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-19
Last Update Date:2015-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADAPT 000136174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1439307OtherPA BS
PA050522946OtherCORPORATE
PA2133068000OtherPERSONAL CHOICE
PA050522946OtherCORPORATE