Provider Demographics
NPI:1689846230
Name:AMANCIO, DEANNA DAWN DAYOLA (PT)
Entity Type:Individual
Prefix:MRS
First Name:DEANNA DAWN
Middle Name:DAYOLA
Last Name:AMANCIO
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2824 NORA LN
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95355-1900
Mailing Address - Country:US
Mailing Address - Phone:209-526-6570
Mailing Address - Fax:562-366-0081
Practice Address - Street 1:3201 W COMMERCIAL BLVD STE 116
Practice Address - Street 2:
Practice Address - City:FT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33309-3444
Practice Address - Country:US
Practice Address - Phone:800-886-8108
Practice Address - Fax:800-370-0755
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-24
Last Update Date:2008-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY029354225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist