Provider Demographics
NPI:1962649277
Name:PERAULT, DANA LEANN (PT)
Entity Type:Individual
Prefix:
First Name:DANA
Middle Name:LEANN
Last Name:PERAULT
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:DANA
Other - Middle Name:LEANN
Other - Last Name:MARTIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1445 NELSON DR
Mailing Address - Street 2:
Mailing Address - City:LYNCHBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24502-2051
Mailing Address - Country:US
Mailing Address - Phone:434-239-2239
Mailing Address - Fax:
Practice Address - Street 1:1900 TATE SPRINGS RD
Practice Address - Street 2:SUITE 16
Practice Address - City:LYNCHBURG
Practice Address - State:VA
Practice Address - Zip Code:24501-1122
Practice Address - Country:US
Practice Address - Phone:434-200-5407
Practice Address - Fax:434-200-7646
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-09
Last Update Date:2009-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305006591225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist