Georgia Theodora Mantis, BCBA

Primary specialty

Behavior AnalystTaxonomy code 103K00000X

License

12258182 Issued in FL

Practice address

1413 Tech Blvd Ste 122
Tampa, FL 33619-7822

Phone

(630) 965-3857

NPI assigned

Mar 16, 2022

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1647388800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1774396800000",
    "number": "1558019752",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1235 S HIGHLAND AVE # 4209",
            "city": "CLEARWATER",
            "state": "FL",
            "postal_code": "337564391",
            "telephone_number": "630-965-3857"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1413 TECH BLVD STE 122",
            "city": "TAMPA",
            "state": "FL",
            "postal_code": "336197822",
            "telephone_number": "630-965-3857"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MANTIS",
        "first_name": "GEORGIA",
        "middle_name": "THEODORA",
        "name_prefix": "Mrs.",
        "credential": "BCBA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-03-16",
        "last_updated": "2026-03-25",
        "certification_date": "2026-03-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103K00000X",
            "taxonomy_group": "",
            "desc": "Behavior Analyst",
            "state": "FL",
            "license": "12258182",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Diana Mansour, RPH
• Joseph Mansour, MD
• Gianna Mansueto, PA-C
• Angela Manteufel, PA-C
• Valeria Mantilla, MD
• Mantra Counseling, LLC
• Melissa Elizabeth Manuelli, MS, LCGC
• Nancy Kathleen Manz, R.N.
• Natalia Aixa Manzano Garcia, PHARMD
• Elizabeth Manzano-Boulton, EDD

• Behavior Analyst in Tampa, FL
• Providers in Tampa, FL by specialty
• Behavior Analyst in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 25, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.