Provider Demographics
NPI:1417068669
Name:AMACK, DANA LEIGH (PT)
Entity Type:Individual
Prefix:MRS
First Name:DANA
Middle Name:LEIGH
Last Name:AMACK
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:DANA
Other - Middle Name:LEIGH
Other - Last Name:COLLINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6668 OWENS DR
Mailing Address - Street 2:
Mailing Address - City:PLEASANTON
Mailing Address - State:CA
Mailing Address - Zip Code:94588-3334
Mailing Address - Country:US
Mailing Address - Phone:925-621-2200
Mailing Address - Fax:925-621-2201
Practice Address - Street 1:6668 OWENS DR
Practice Address - Street 2:
Practice Address - City:PLEASANTON
Practice Address - State:CA
Practice Address - Zip Code:94588-3334
Practice Address - Country:US
Practice Address - Phone:925-621-2200
Practice Address - Fax:925-621-2201
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2007-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT12860225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist