Provider Demographics
NPI:1760684344
Name:DANO-BAJALA, JEYRA (PT)
Entity Type:Individual
Prefix:
First Name:JEYRA
Middle Name:
Last Name:DANO-BAJALA
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 1:10702 DEERBERRY DR
Mailing Address - Street 2:
Mailing Address - City:LAND O LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:34638-6892
Mailing Address - Country:US
Mailing Address - Phone:813-929-8197
Mailing Address - Fax:
Practice Address - Street 1:7775 MOKENA CT
Practice Address - Street 2:
Practice Address - City:NEW PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34654-5647
Practice Address - Country:US
Practice Address - Phone:727-452-6675
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL114212251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics