Individual
DOUGLAS MANCILLA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PT, DPT
Contact information
Practice address
3180 CURLEW RD, OLDSMAR, FL 34677-2629
(813) 343-4840
Mailing address
21756 STATE ROAD 54, STE 102, LUTZ, FL 33549-2905
(727) 475-5540
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT34144
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PT34144
PT LICENSE
FL
Enumeration date
01/15/2019
Last updated
04/07/2022
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