Provider Demographics
NPI:1386271831
Name:MANI, MERIL ANN (DPT)
Entity type:Individual
Prefix:
First Name:MERIL
Middle Name:ANN
Last Name:MANI
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 S 1ST ST UNIT A301
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55401-1800
Mailing Address - Country:US
Mailing Address - Phone:312-513-3121
Mailing Address - Fax:
Practice Address - Street 1:715 S 8TH ST FL 3
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55404-1210
Practice Address - Country:US
Practice Address - Phone:612-873-4377
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-25
Last Update Date:2020-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN116752251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN00000000000Medicaid
MN0000000OtherMEDICA, HUMANA, HEALTH PARTNERS, BCBS, PRIVATE INSURANCES