Provider Demographics
NPI:1154086577
Name:PROK, DEANA (PTA)
Entity Type:Individual
Prefix:
First Name:DEANA
Middle Name:
Last Name:PROK
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:633 N OCOEE ST APT 5
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:TN
Mailing Address - Zip Code:37311-2278
Mailing Address - Country:US
Mailing Address - Phone:423-584-5058
Mailing Address - Fax:
Practice Address - Street 1:633 N OCOEE ST APT 5
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:TN
Practice Address - Zip Code:37311-2278
Practice Address - Country:US
Practice Address - Phone:423-584-5058
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-01
Last Update Date:2021-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN7202225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant