Provider Demographics
NPI:1083988000
Name:JAVALERA, DANAH ANDREA (PT)
Entity Type:Individual
Prefix:MRS
First Name:DANAH
Middle Name:ANDREA
Last Name:JAVALERA
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MISS
Other - First Name:DANAH
Other - Middle Name:ANDREA
Other - Last Name:MENDOZA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:345 S 16TH ST
Mailing Address - Street 2:APT H20
Mailing Address - City:LEBANON
Mailing Address - State:PA
Mailing Address - Zip Code:17042-5875
Mailing Address - Country:US
Mailing Address - Phone:571-499-8319
Mailing Address - Fax:
Practice Address - Street 1:945 DUKE ST
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:PA
Practice Address - Zip Code:17042-7216
Practice Address - Country:US
Practice Address - Phone:717-274-1495
Practice Address - Fax:717-389-0227
Is Sole Proprietor?:No
Enumeration Date:2012-03-08
Last Update Date:2012-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT020495225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA396822Medicare Oscar/Certification