Active NPI
Rudolph Manna
- Behavior Technician
- Stuart, FL
National Provider Identifier
1801411640
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Technician
- License
- 581849
- Practice address
- 900 SE Ocean Blvd
Stuart, FL 34994-2471 - Phone
- (772) 219-7575
- NPI assigned
- Jun 8, 2020
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Behavior Technician | 106S00000X | 581849 | FL | Primary |
Addresses
Primary practice location
900 SE Ocean Blvd
Stuart, FL 34994-2471
Mailing address
925 SE Albatross Ave
Port Saint Lucie, FL 34983-3903
Phone (407) 914-3154
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 581849 | FL | MD | Behavior Technician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1591574400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1591574400000",
"number": "1801411640",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "925 SE ALBATROSS AVE",
"city": "PORT SAINT LUCIE",
"state": "FL",
"postal_code": "349833903",
"telephone_number": "407-914-3154"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "900 SE OCEAN BLVD",
"city": "STUART",
"state": "FL",
"postal_code": "349942471",
"telephone_number": "772-219-7575"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MANNA",
"first_name": "RUDOLPH",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2020-06-08",
"last_updated": "2020-06-08",
"certification_date": "2020-06-08",
"status": "A"
},
"taxonomies": [
{
"code": "106S00000X",
"taxonomy_group": "",
"desc": "Behavior Technician",
"state": "FL",
"license": "581849",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Stuart, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 8, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.