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Individual
LAURIE JOAN MANDEL
Active
Individual
LAURIE JOAN MANDEL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT006400L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00025348902
UNIVERA
NY
05
—
0016911470011
—
PA
01
—
274486
BLUE SHIELD
PA
01
—
3110693
AETNA
PA
01
—
P00111381
RR MEDICARE
PA
Enumeration date
07/26/2005
Last updated
05/06/2008
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