Provider Demographics
NPI:1750556510
Name:JM PHYSICAL THERAPY, PC
Entity type:Organization
Organization Name:JM PHYSICAL THERAPY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF PHYSICAL THERAPY
Authorized Official - Prefix:MR
Authorized Official - First Name:JACK
Authorized Official - Middle Name:M
Authorized Official - Last Name:MANTIONE
Authorized Official - Suffix:III
Authorized Official - Credentials:DPT, CSCS
Authorized Official - Phone:212-334-7441
Mailing Address - Street 1:55 WHITE ST APT 5A
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10013-3580
Mailing Address - Country:US
Mailing Address - Phone:212-334-7441
Mailing Address - Fax:
Practice Address - Street 1:55 WHITE ST APT 5A
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10013-3580
Practice Address - Country:US
Practice Address - Phone:212-334-7441
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-23
Last Update Date:2008-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Single Specialty