Provider Demographics
NPI:1891128567
Name:DAMAS, MARIE WALEWSKA (PTA)
Entity Type:Individual
Prefix:
First Name:MARIE
Middle Name:WALEWSKA
Last Name:DAMAS
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1800 PRIMROSE LN
Mailing Address - Street 2:
Mailing Address - City:WELLINGTON
Mailing Address - State:FL
Mailing Address - Zip Code:33414-8673
Mailing Address - Country:US
Mailing Address - Phone:561-306-2234
Mailing Address - Fax:
Practice Address - Street 1:1800 PRIMROSE LN
Practice Address - Street 2:
Practice Address - City:WELLINGTON
Practice Address - State:FL
Practice Address - Zip Code:33414-8673
Practice Address - Country:US
Practice Address - Phone:561-306-2234
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-16
Last Update Date:2013-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPTA23998225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant