Provider Demographics
NPI:1134176456
Name:FORTUNA, DAWN SHERRI (PTA)
Entity type:Individual
Prefix:MS
First Name:DAWN
Middle Name:SHERRI
Last Name:FORTUNA
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 1:1923 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:BOOTHWYN
Mailing Address - State:PA
Mailing Address - Zip Code:19061-3625
Mailing Address - Country:US
Mailing Address - Phone:610-485-3782
Mailing Address - Fax:
Practice Address - Street 1:30 E 10TH ST
Practice Address - Street 2:
Practice Address - City:MARCUS HOOK
Practice Address - State:PA
Practice Address - Zip Code:19061-4515
Practice Address - Country:US
Practice Address - Phone:610-859-9110
Practice Address - Fax:610-859-9221
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEJ2-0000493225200000X
PATE005709L225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant