Provider Demographics
NPI:1861902363
Name:MANISCALCO, JESSIE M (PT)
Entity type:Individual
Prefix:
First Name:JESSIE
Middle Name:M
Last Name:MANISCALCO
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:168 INDUSTRIAL DR
Mailing Address - Street 2:
Mailing Address - City:MASHPEE
Mailing Address - State:MA
Mailing Address - Zip Code:02649-3561
Mailing Address - Country:US
Mailing Address - Phone:508-477-4800
Mailing Address - Fax:508-477-5377
Practice Address - Street 1:168 INDUSTRIAL DR
Practice Address - Street 2:
Practice Address - City:MASHPEE
Practice Address - State:MA
Practice Address - Zip Code:02649-3561
Practice Address - Country:US
Practice Address - Phone:508-477-4800
Practice Address - Fax:508-477-5377
Is Sole Proprietor?:No
Enumeration Date:2017-10-10
Last Update Date:2020-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT116112251P0200X
MA24210225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics