National Provider Identifier
Jeremy Peter Mang
Jeremy Peter Mang is listed in the NPPES registry with a primary specialty of Physical Therapist in Gasport, NY and a listed phone number of (716) 772-2631.
Profile Overview
- NPI
- 1881290740
- Provider Type
- Individual
- Primary Specialty
- Physical Therapist
- Enumeration Date
- December 07, 2020
- Last Updated
- December 07, 2020
Practice Location
- 4540 Lincoln Dr
- Gasport, NY 14067-9212
Phone: (716) 772-2631
Specialties
- Physical Therapist (225100000X)
Full Record
- NPI
- 1881290740
- Entity Type
- Individual
- Last Name
- Mang
- First Name
- Jeremy
- Middle Name
- Peter
- Mailing Street Address
- 4540 Lincoln Dr
- Mailing City
- Gasport
- Mailing State
- NY
- Mailing ZIP Code
- 14067-9212
- Mailing Country
- US
- Practice Street Address
- 4540 Lincoln Dr
- Practice City
- Gasport
- Practice State
- NY
- Practice ZIP Code
- 14067-9212
- Practice Country
- US
- Practice Phone
- (716) 772-2631
- Enumeration Date
- December 07, 2020
- Last Updated
- December 07, 2020
- Sex
- Male
- Sole Proprietor
- No
- Certification Date
- December 07, 2020
- updated_by_file
- npidata_pfile_20050523-20260308.csv
- Taxonomies
- Physical Therapist (225100000X)