Provider Demographics
NPI:1952492852
Name:CARNAHAN, DANA (PT)
Entity Type:Individual
Prefix:
First Name:DANA
Middle Name:
Last Name:CARNAHAN
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6659 KIMBALL DR
Mailing Address - Street 2:SUITE A101
Mailing Address - City:GIG HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98335-5137
Mailing Address - Country:US
Mailing Address - Phone:253-857-4870
Mailing Address - Fax:253-857-4876
Practice Address - Street 1:6659 KIMBALL DR
Practice Address - Street 2:SUITE A101
Practice Address - City:GIG HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98335-5137
Practice Address - Country:US
Practice Address - Phone:253-857-4870
Practice Address - Fax:253-857-4876
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00003282225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA4886CAOtherREGENCE RIDER NUMBER
WAAB39718Medicare ID - Type UnspecifiedINDIV MEDICARE NUMBER