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Individual
KEVIN TIMOTHY MANGAN
Active
Individual
KEVIN TIMOTHY MANGAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PT,DPT
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
014577
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
Q570A1
EMPIRE BLUE CROSS BLUE SHIELD
NY
Enumeration date
09/26/2006
Last updated
01/27/2015
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