Provider Demographics
NPI:1447907647
Name:MANI, MARISHA
Entity type:Individual
Prefix:MRS
First Name:MARISHA
Middle Name:
Last Name:MANI
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:MARISHA
Other - Middle Name:
Other - Last Name:MANI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MARISHA JOSE
Mailing Address - Street 1:800 S RIVER RD
Mailing Address - Street 2:
Mailing Address - City:DES PLAINES
Mailing Address - State:IL
Mailing Address - Zip Code:60016-8419
Mailing Address - Country:US
Mailing Address - Phone:847-294-0100
Mailing Address - Fax:847-699-1955
Practice Address - Street 1:800 S RIVER RD
Practice Address - Street 2:
Practice Address - City:DES PLAINES
Practice Address - State:IL
Practice Address - Zip Code:60016-8419
Practice Address - Country:US
Practice Address - Phone:847-294-0100
Practice Address - Fax:847-699-1955
Is Sole Proprietor?:No
Enumeration Date:2022-03-07
Last Update Date:2022-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070016789225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist