Individual ProviderDomenic MainelliPhysical TherapistRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPractice Address3599 University Blvd S, Jacksonville, FL 32216-4252(904) 858-7600PECOS EnrollmentBased on the most recent information from CMS, provider Domenic Mainelli does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records 6 days ago.Profile DetailsProvider ID1437459419Provider TypeIndividualFull NameMainelli, DomenicGenderMaleSole ProprietorYesEnumeration Date10/25/2010Last Updated10/25/2010Contact InformationPractice LocationPractice Address3599 University Blvd S, Jacksonville, FL 32216-4252Phone(904) 858-7600FaxUnlisted FaxMailing LocationMailing Address211 Arpieka Ave, Apartment 5, Saint Augustine, FL 32080-2701PhoneUnlisted PhoneFaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode225100000XPrimaryDescriptionPhysical TherapistRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersLicensePT25921Florida