Provider Demographics
NPI:1063008357
Name:DIMAANO, EARL NORBERT O (DPT)
Entity Type:Individual
Prefix:
First Name:EARL NORBERT
Middle Name:O
Last Name:DIMAANO
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7451 103RD ST STE 12
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32210-6788
Mailing Address - Country:US
Mailing Address - Phone:904-771-3679
Mailing Address - Fax:
Practice Address - Street 1:7451 103RD ST STE 12
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32210-6788
Practice Address - Country:US
Practice Address - Phone:904-771-3679
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-21
Last Update Date:2020-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT366112251G0304X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatrics