Provider Demographics
NPI:1407432461
Name:DAYANDANTE, RODISA (PTA)
Entity Type:Individual
Prefix:
First Name:RODISA
Middle Name:
Last Name:DAYANDANTE
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 1:502 N MAIN ST UNIT 3014
Mailing Address - Street 2:
Mailing Address - City:WEATHERFORD
Mailing Address - State:TX
Mailing Address - Zip Code:76086-2462
Mailing Address - Country:US
Mailing Address - Phone:409-540-8685
Mailing Address - Fax:
Practice Address - Street 1:502 N MAIN ST UNIT 3014
Practice Address - Street 2:
Practice Address - City:WEATHERFORD
Practice Address - State:TX
Practice Address - Zip Code:76086-2462
Practice Address - Country:US
Practice Address - Phone:409-540-8685
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-21
Last Update Date:2021-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2151312225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant