Provider Demographics
NPI:1780498071
Name:MANELIS, ANNA (DPT, PHD)
Entity type:Individual
Prefix:
First Name:ANNA
Middle Name:
Last Name:MANELIS
Suffix:
Gender:F
Credentials:DPT, PHD
Other - Prefix:
Other - First Name:ANNA
Other - Middle Name:
Other - Last Name:CHEREMNYKH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:50 CHARLIE WAY
Mailing Address - Street 2:
Mailing Address - City:ST AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32095-7542
Mailing Address - Country:US
Mailing Address - Phone:848-467-1817
Mailing Address - Fax:
Practice Address - Street 1:9601 SOUTHBROOK DR
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32256-0601
Practice Address - Country:US
Practice Address - Phone:448-234-2490
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-05
Last Update Date:2025-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL42804225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist