Provider Demographics
NPI:1245597194
Name:VALENCIA, DANA LYNN (MPT)
Entity Type:Individual
Prefix:
First Name:DANA
Middle Name:LYNN
Last Name:VALENCIA
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13891 NEWPORT AVE STE 285
Mailing Address - Street 2:
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92780-7840
Mailing Address - Country:US
Mailing Address - Phone:714-770-8222
Mailing Address - Fax:714-770-8210
Practice Address - Street 1:13891 NEWPORT AVE STE 285
Practice Address - Street 2:
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92780-7840
Practice Address - Country:US
Practice Address - Phone:714-770-8222
Practice Address - Fax:714-770-8210
Is Sole Proprietor?:No
Enumeration Date:2012-04-17
Last Update Date:2014-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA25687225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist