Mandy Baniszewski
Individual provider Active NPI Physical Therapist · Southbury, CT
NPI 1013590199 · NPPES record last updated May 5, 2021
Key facts
- NPI
- 1013590199
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physical Therapist 225100000X
- License
- 12995 (CT)
- Practice address
- 655 Main St S
Southbury, CT 06488-4220 - Phone
- (877) 407-3422
- Fax
- (877) 407-4329
- NPI assigned
- May 5, 2021
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 12995 | CT | MD | Physical Therapist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 12995 | CT | Yes |
Addresses
Primary practice location
655 Main St S
Southbury, CT 06488-4220
Mailing address
7 Carnegie PLZ
Cherry Hill, NJ 08003-1000
Phone (877) 407-3422
Other providers in Southbury, CT
- Francis Atallah
- Amber Auger
- Stephanie L. Bakewell
- Lisa Baldelli
- Laura Baltzell
- Mary Jacqueline Banning
- Sarah Bannon
- Barbara a. Kilkenny, DPM
- Barbara a. Kilkenny, PC
- Barbell Physical Therapy and Performance, LLC
All providers in Southbury, CT · Physical Therapist in Connecticut
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 5, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.