Provider Demographics
NPI:1457591018
Name:MANIACI, MICHELLE (PT)
Entity type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:
Last Name:MANIACI
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1408 BRICKELL BAY DR
Mailing Address - Street 2:SUITE #1018
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33131-3697
Mailing Address - Country:US
Mailing Address - Phone:305-206-2229
Mailing Address - Fax:
Practice Address - Street 1:1408 BRICKELL BAY DR
Practice Address - Street 2:SUITE #1018
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33131-3697
Practice Address - Country:US
Practice Address - Phone:305-206-2229
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-23
Last Update Date:2009-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT-15116225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL884232900Medicaid