Provider Demographics
NPI:1710654132
Name:DEVAGNO, DANA (PT)
Entity Type:Individual
Prefix:
First Name:DANA
Middle Name:
Last Name:DEVAGNO
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4230 JACK FROST CT APT 6
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34112-5200
Mailing Address - Country:US
Mailing Address - Phone:239-248-0619
Mailing Address - Fax:
Practice Address - Street 1:770 GOODLETTE RD
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34102-5607
Practice Address - Country:US
Practice Address - Phone:239-280-4360
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-24
Last Update Date:2021-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT18263225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist