Provider Demographics
NPI:1679351779
Name:MANZINI, MICHAELIA RAE
Entity type:Individual
Prefix:
First Name:MICHAELIA
Middle Name:RAE
Last Name:MANZINI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3476 S 5175 W
Mailing Address - Street 2:
Mailing Address - City:CEDAR CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84720-6898
Mailing Address - Country:US
Mailing Address - Phone:775-316-0382
Mailing Address - Fax:
Practice Address - Street 1:168 N 100 E
Practice Address - Street 2:
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84770-2893
Practice Address - Country:US
Practice Address - Phone:775-316-0382
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-19
Last Update Date:2025-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT14232820-4701225700000X
NV8325225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty