Provider Demographics
NPI:1801030937
Name:DEA, DANIELLE ELIZABETH
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:ELIZABETH
Last Name:DEA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3903 NORTHDALE BLVD
Mailing Address - Street 2:111W
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33624-1864
Mailing Address - Country:US
Mailing Address - Phone:813-418-7350
Mailing Address - Fax:813-265-2504
Practice Address - Street 1:9415 SUNSET DR
Practice Address - Street 2:STE 111
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33173-5427
Practice Address - Country:US
Practice Address - Phone:305-279-4071
Practice Address - Fax:305-279-6293
Is Sole Proprietor?:No
Enumeration Date:2009-04-20
Last Update Date:2013-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT24643225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist