Provider Demographics
NPI:1235619172
Name:DEEN, DAVINA ANDREA (PTA)
Entity Type:Individual
Prefix:
First Name:DAVINA
Middle Name:ANDREA
Last Name:DEEN
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 1:3912 SAN LUIS CT
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76016-2741
Mailing Address - Country:US
Mailing Address - Phone:816-217-1658
Mailing Address - Fax:
Practice Address - Street 1:4515 VILLAGE CREEK RD
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76119-4158
Practice Address - Country:US
Practice Address - Phone:817-451-8704
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-20
Last Update Date:2018-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2129301225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant