Provider Demographics
NPI:1609408913
Name:TURNER, DESIRAE TIANA
Entity Type:Individual
Prefix:
First Name:DESIRAE
Middle Name:TIANA
Last Name:TURNER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1004 N WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:DE
Mailing Address - Zip Code:19963-1244
Mailing Address - Country:US
Mailing Address - Phone:302-503-0440
Mailing Address - Fax:302-449-2047
Practice Address - Street 1:1004 N WALNUT ST
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:DE
Practice Address - Zip Code:19963-1244
Practice Address - Country:US
Practice Address - Phone:302-503-0440
Practice Address - Fax:302-449-2047
Is Sole Proprietor?:No
Enumeration Date:2020-02-05
Last Update Date:2020-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEJ1-0004173225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist