Provider Demographics
NPI:1285846758
Name:GUALTIERI, DANA DELENE (PTA)
Entity Type:Individual
Prefix:
First Name:DANA
Middle Name:DELENE
Last Name:GUALTIERI
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 1:7770 NW 79TH AVE APT E2
Mailing Address - Street 2:
Mailing Address - City:TAMARAC
Mailing Address - State:FL
Mailing Address - Zip Code:33321-2899
Mailing Address - Country:US
Mailing Address - Phone:727-415-9511
Mailing Address - Fax:
Practice Address - Street 1:27835 PLEASURE RIDE LOOP
Practice Address - Street 2:
Practice Address - City:WESLEY CHAPEL
Practice Address - State:FL
Practice Address - Zip Code:33543-8142
Practice Address - Country:US
Practice Address - Phone:727-415-9511
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL19080225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant