Provider Demographics
NPI:1093991374
Name:FOREMAN, DANA (PT)
Entity Type:Individual
Prefix:
First Name:DANA
Middle Name:
Last Name:FOREMAN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 DARIEN CT
Mailing Address - Street 2:APT 2C
Mailing Address - City:POMONA
Mailing Address - State:NY
Mailing Address - Zip Code:10970-3008
Mailing Address - Country:US
Mailing Address - Phone:845-774-6419
Mailing Address - Fax:
Practice Address - Street 1:1940 COMMERCE STREET, SUITE 210
Practice Address - Street 2:PRIME REHABILITATION SERVICES
Practice Address - City:YORKTOWN HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:10598
Practice Address - Country:US
Practice Address - Phone:914-631-9020
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-16
Last Update Date:2011-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY029596225100000X
NJ40QA01260900225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist