Provider Demographics
NPI:1184772857
Name:HAVNER, DEAN ERIC (PT)
Entity type:Individual
Prefix:
First Name:DEAN
Middle Name:ERIC
Last Name:HAVNER
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 1:6376 PINE RIDGE RD UNIT 430
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34119-3928
Mailing Address - Country:US
Mailing Address - Phone:239-316-7600
Mailing Address - Fax:239-316-7509
Practice Address - Street 1:6376 PINE RIDGE RD UNIT 430
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34119-3928
Practice Address - Country:US
Practice Address - Phone:239-316-7600
Practice Address - Fax:239-316-7509
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2023-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT368952251X0800X
NY0185852251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA400027418Medicare PIN