Provider Demographics
NPI:1588036628
Name:CHARLES, DANIA K (PTA)
Entity Type:Individual
Prefix:
First Name:DANIA
Middle Name:K
Last Name:CHARLES
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 1:854 SE FESTIVO CT
Mailing Address - Street 2:
Mailing Address - City:PORT SAINT LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34983-2026
Mailing Address - Country:US
Mailing Address - Phone:772-626-9603
Mailing Address - Fax:
Practice Address - Street 1:854 SE FESTIVO CT
Practice Address - Street 2:
Practice Address - City:PORT SAINT LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34983-2026
Practice Address - Country:US
Practice Address - Phone:772-626-9603
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-28
Last Update Date:2015-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPTA25839225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant