Provider Demographics
NPI:1003073230
Name:TITTO, DAWN M (PTA)
Entity Type:Individual
Prefix:
First Name:DAWN
Middle Name:M
Last Name:TITTO
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:311 S CYPRESS RD
Mailing Address - Street 2:
Mailing Address - City:POMPANO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33060-7133
Mailing Address - Country:US
Mailing Address - Phone:954-781-7248
Mailing Address - Fax:954-781-7313
Practice Address - Street 1:311 S CYPRESS RD
Practice Address - Street 2:
Practice Address - City:POMPANO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33060-7133
Practice Address - Country:US
Practice Address - Phone:954-781-7248
Practice Address - Fax:954-781-7313
Is Sole Proprietor?:No
Enumeration Date:2008-05-16
Last Update Date:2008-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPTA9371225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPTA9371OtherPTA LICENSE NO