Provider Demographics
NPI:1609535145
Name:MANESS HOLDING COMPANY LLC
Entity Type:Organization
Organization Name:MANESS HOLDING COMPANY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:GOVINDA
Authorized Official - Last Name:MANESS
Authorized Official - Suffix:
Authorized Official - Credentials:MSOT
Authorized Official - Phone:561-802-8074
Mailing Address - Street 1:1729 NW SAINT LUCIE WEST BLVD # 1097
Mailing Address - Street 2:
Mailing Address - City:PORT SAINT LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34986-2501
Mailing Address - Country:US
Mailing Address - Phone:561-802-8074
Mailing Address - Fax:
Practice Address - Street 1:4413 NW ALSACE AVE
Practice Address - Street 2:
Practice Address - City:PORT SAINT LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34983
Practice Address - Country:US
Practice Address - Phone:561-802-8074
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-13
Last Update Date:2021-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation