Provider Demographics
NPI:1063857092
Name:NEWLIN, DEANNA LEE (LMT)
Entity Type:Individual
Prefix:
First Name:DEANNA
Middle Name:LEE
Last Name:NEWLIN
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 161ST AVE
Mailing Address - Street 2:
Mailing Address - City:REDINGTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33708-1652
Mailing Address - Country:US
Mailing Address - Phone:727-678-3779
Mailing Address - Fax:
Practice Address - Street 1:34876 US 19 N
Practice Address - Street 2:
Practice Address - City:PALM HARBOR
Practice Address - State:FL
Practice Address - Zip Code:34684-1918
Practice Address - Country:US
Practice Address - Phone:727-216-3972
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-03
Last Update Date:2013-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA72505171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor