Provider Demographics
NPI:1164021176
Name:DANGAN, DAVE AARON
Entity Type:Individual
Prefix:
First Name:DAVE
Middle Name:AARON
Last Name:DANGAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1750 LONGLEAF BLVD STE 5&6
Mailing Address - Street 2:
Mailing Address - City:LAKE WALES
Mailing Address - State:FL
Mailing Address - Zip Code:33859-2504
Mailing Address - Country:US
Mailing Address - Phone:863-678-0705
Mailing Address - Fax:863-678-0700
Practice Address - Street 1:1750 LONGLEAF BLVD STE 5&6
Practice Address - Street 2:
Practice Address - City:LAKE WALES
Practice Address - State:FL
Practice Address - Zip Code:33859-2504
Practice Address - Country:US
Practice Address - Phone:863-678-0705
Practice Address - Fax:863-678-0700
Is Sole Proprietor?:No
Enumeration Date:2020-10-21
Last Update Date:2020-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT36414225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist