Provider Demographics
NPI:1972160356
Name:MITRY-HANA, MARINA A (DPT, OTR/L)
Entity Type:Individual
Prefix:DR
First Name:MARINA
Middle Name:A
Last Name:MITRY-HANA
Suffix:
Gender:F
Credentials:DPT, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1717 NORTH CLYDE MORRIS BLVD.
Mailing Address - Street 2:SUITE 140
Mailing Address - City:DAYTONA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32117
Mailing Address - Country:US
Mailing Address - Phone:386-257-2672
Mailing Address - Fax:386-252-1005
Practice Address - Street 1:1717 NORTH CLYDE MORRIS BLVD.
Practice Address - Street 2:SUITE 140
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32117
Practice Address - Country:US
Practice Address - Phone:386-257-2672
Practice Address - Fax:386-252-1005
Is Sole Proprietor?:No
Enumeration Date:2019-05-21
Last Update Date:2023-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT18823225X00000X
FLPT34562225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist