Provider Demographics
NPI:1487610366
Name:MANCHAK, PATRICIA FANNYA (PT)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:FANNYA
Last Name:MANCHAK
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1377 MOTOR PKWY STE 307
Mailing Address - Street 2:
Mailing Address - City:ISLANDIA
Mailing Address - State:NY
Mailing Address - Zip Code:11749-5258
Mailing Address - Country:US
Mailing Address - Phone:631-580-5200
Mailing Address - Fax:631-760-8306
Practice Address - Street 1:2714 PHILADELPHIA PIKE
Practice Address - Street 2:
Practice Address - City:CLAYMONT
Practice Address - State:DE
Practice Address - Zip Code:19703-2568
Practice Address - Country:US
Practice Address - Phone:302-408-7310
Practice Address - Fax:302-416-4817
Is Sole Proprietor?:No
Enumeration Date:2006-04-21
Last Update Date:2020-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT009427L225100000X
DEJ1-0001028225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE0479677000OtherIBC
DE1487610366Medicaid
DE1487610366OtherDPCI
254215OtherUNISON
PA102373515-0001Medicaid
DEP00692875OtherRAILROAD MEDICARE
5916630OtherAETNA
DE140925ZB82Medicare PIN