Provider Demographics
NPI:1689083008
Name:MANIERI, RACHELLE (LMT)
Entity Type:Individual
Prefix:
First Name:RACHELLE
Middle Name:
Last Name:MANIERI
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35602 N GREEN PL
Mailing Address - Street 2:
Mailing Address - City:WAUKEGAN
Mailing Address - State:IL
Mailing Address - Zip Code:60085-1228
Mailing Address - Country:US
Mailing Address - Phone:847-875-5684
Mailing Address - Fax:
Practice Address - Street 1:35602 N GREEN PL
Practice Address - Street 2:
Practice Address - City:WAUKEGAN
Practice Address - State:IL
Practice Address - Zip Code:60085-1228
Practice Address - Country:US
Practice Address - Phone:847-875-5684
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-11
Last Update Date:2015-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL227-011909225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist