Provider Demographics
NPI:1376943290
Name:EDGAR, DANA JANETTER VELASCO (PT)
Entity Type:Individual
Prefix:MRS
First Name:DANA
Middle Name:JANETTER VELASCO
Last Name:EDGAR
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9460 N NAME UNO
Mailing Address - Street 2:STE 140
Mailing Address - City:GILROY
Mailing Address - State:CA
Mailing Address - Zip Code:95020-3537
Mailing Address - Country:US
Mailing Address - Phone:408-847-0107
Mailing Address - Fax:
Practice Address - Street 1:9460 N NAME UNO
Practice Address - Street 2:STE 140
Practice Address - City:GILROY
Practice Address - State:CA
Practice Address - Zip Code:95020-3537
Practice Address - Country:US
Practice Address - Phone:408-847-0107
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-27
Last Update Date:2022-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT21164225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist