Provider Demographics
NPI:1568797884
Name:DRAKE, ANISHA (DPT)
Entity Type:Individual
Prefix:DR
First Name:ANISHA
Middle Name:
Last Name:DRAKE
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:ANISHA
Other - Middle Name:
Other - Last Name:PAI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 518
Mailing Address - Street 2:SUITE C
Mailing Address - City:WILLISTON
Mailing Address - State:FL
Mailing Address - Zip Code:32696-0518
Mailing Address - Country:US
Mailing Address - Phone:352-528-0022
Mailing Address - Fax:352-528-2878
Practice Address - Street 1:1315 NW 21ST AVE STE 3
Practice Address - Street 2:
Practice Address - City:CHIEFLAND
Practice Address - State:FL
Practice Address - Zip Code:32626-1978
Practice Address - Country:US
Practice Address - Phone:352-493-2999
Practice Address - Fax:352-493-0026
Is Sole Proprietor?:No
Enumeration Date:2009-10-04
Last Update Date:2010-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT 25021225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist