Individual
MIA MARIE MANCUSO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
2500 ADAMS AVE, SCRANTON, PA 18509-1515
(570) 343-4065
Mailing address
107 TAROLI ST, OLD FORGE, PA 18518-1952
(570) 955-6794
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
TEI004330
PA
Other
Enumeration date
08/13/2020
Last updated
08/13/2020
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