Individual
PATRICIA FANNYA MANCHAK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
P.T.
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
J1-0001028
DE
225100000X
Physical Therapist
PT009427L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0479677000
IBC
DE
05
—
102373515-0001
—
PA
01
—
1487610366
DPCI
DE
05
—
1487610366
—
DE
01
—
254215
UNISON
—
01
—
5916630
AETNA
—
01
—
P00692875
RAILROAD MEDICARE
DE
Enumeration date
04/21/2006
Last updated
08/21/2020
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