Provider Demographics
NPI:1922445477
Name:DE LA PENA, DANA TEE (RPT)
Entity Type:Individual
Prefix:MRS
First Name:DANA
Middle Name:TEE
Last Name:DE LA PENA
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5800 W SAMPLE RD
Mailing Address - Street 2:APT.206
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33067-3234
Mailing Address - Country:US
Mailing Address - Phone:954-344-4145
Mailing Address - Fax:
Practice Address - Street 1:5800 W SAMPLE RD
Practice Address - Street 2:APT.206
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33067-3234
Practice Address - Country:US
Practice Address - Phone:954-344-4145
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-23
Last Update Date:2013-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1229671225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist