Provider Demographics
NPI:1871919761
Name:MANI, SATHISH KUMAR
Entity type:Individual
Prefix:
First Name:SATHISH KUMAR
Middle Name:
Last Name:MANI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 ANDERSON AVE
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:VA
Mailing Address - Zip Code:22427-9401
Mailing Address - Country:US
Mailing Address - Phone:909-907-2821
Mailing Address - Fax:
Practice Address - Street 1:20 MANOR DR
Practice Address - Street 2:
Practice Address - City:OSWEGO
Practice Address - State:NY
Practice Address - Zip Code:13126-6495
Practice Address - Country:US
Practice Address - Phone:315-349-5300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-03-15
Last Update Date:2024-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225100000X
NY034552225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist