Provider Demographics
NPI:1114315280
Name:CVITANOV, BEVERLEE DANIELLE (DPT)
Entity Type:Individual
Prefix:DR
First Name:BEVERLEE
Middle Name:DANIELLE
Last Name:CVITANOV
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3913 LASUEN DR
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95821-6526
Mailing Address - Country:US
Mailing Address - Phone:916-715-3641
Mailing Address - Fax:
Practice Address - Street 1:9381 E STOCKTON BLVD STE 108
Practice Address - Street 2:
Practice Address - City:ELK GROVE
Practice Address - State:CA
Practice Address - Zip Code:95624-5069
Practice Address - Country:US
Practice Address - Phone:916-686-5077
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-24
Last Update Date:2014-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA42089225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist