Provider Demographics
NPI:1740805308
Name:HALLAHAN, DEANNA MARIE (PT)
Entity Type:Individual
Prefix:MRS
First Name:DEANNA
Middle Name:MARIE
Last Name:HALLAHAN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MISS
Other - First Name:DEANNA
Other - Middle Name:MARIE
Other - Last Name:DITOMMASO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:276 TIMBERLINE TRL
Mailing Address - Street 2:
Mailing Address - City:ORMOND BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32174-4988
Mailing Address - Country:US
Mailing Address - Phone:386-236-8057
Mailing Address - Fax:
Practice Address - Street 1:276 TIMBERLINE TRL
Practice Address - Street 2:
Practice Address - City:ORMOND BEACH
Practice Address - State:FL
Practice Address - Zip Code:32174-4988
Practice Address - Country:US
Practice Address - Phone:386-236-8057
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-10
Last Update Date:2020-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL4301225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist