Provider Demographics
NPI:1619404787
Name:MANESS, PATRICK (MSOT)
Entity type:Individual
Prefix:MR
First Name:PATRICK
Middle Name:
Last Name:MANESS
Suffix:
Gender:M
Credentials:MSOT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1729 NW SAINT LUCIE WEST BLVD # 1141
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:772-206-0629
Mailing Address - Fax:949-437-3168
Practice Address - Street 1:1729 NW SAINT LUCIE WEST BLVD # 1141
Practice Address - Street 2:
Practice Address - City:PORT SAINT LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34986-2501
Practice Address - Country:US
Practice Address - Phone:772-206-0629
Practice Address - Fax:949-437-3168
Is Sole Proprietor?:No
Enumeration Date:2017-05-18
Last Update Date:2025-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT21001225X00000X, 225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL120071300Medicaid