Provider Demographics
NPI:1710357413
Name:DANZEISEN, CLARA (PT, DPT)
Entity Type:Individual
Prefix:
First Name:CLARA
Middle Name:
Last Name:DANZEISEN
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6474 RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:PORT RICHEY
Mailing Address - State:FL
Mailing Address - Zip Code:34668-6748
Mailing Address - Country:US
Mailing Address - Phone:727-846-0547
Mailing Address - Fax:727-847-0755
Practice Address - Street 1:6474 RIDGE RD
Practice Address - Street 2:
Practice Address - City:PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34668-6748
Practice Address - Country:US
Practice Address - Phone:727-846-0547
Practice Address - Fax:727-847-0755
Is Sole Proprietor?:No
Enumeration Date:2015-10-07
Last Update Date:2015-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT 30837225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist