Provider Demographics
NPI:1497899215
Name:KLINGER, D'ANNA NICOLE (PT)
Entity Type:Individual
Prefix:
First Name:D'ANNA
Middle Name:NICOLE
Last Name:KLINGER
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 1:3418 RISING FAWN TRL
Mailing Address - Street 2:
Mailing Address - City:SUWANEE
Mailing Address - State:GA
Mailing Address - Zip Code:30024-3639
Mailing Address - Country:US
Mailing Address - Phone:706-799-3515
Mailing Address - Fax:855-751-0172
Practice Address - Street 1:3418 RISING FAWN TRL
Practice Address - Street 2:
Practice Address - City:SUWANEE
Practice Address - State:GA
Practice Address - Zip Code:30024-3639
Practice Address - Country:US
Practice Address - Phone:706-799-3515
Practice Address - Fax:855-396-0161
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-16
Last Update Date:2021-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT008973225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA164236100AMedicaid
GA65BBDZNMedicare PIN