Provider Demographics
NPI:1205108008
Name:DAVANELOS, MARIA GEORGIA (DPT)
Entity type:Individual
Prefix:MRS
First Name:MARIA
Middle Name:GEORGIA
Last Name:DAVANELOS
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:MS
Other - First Name:MARIA
Other - Middle Name:GEORGIA
Other - Last Name:TRAKAS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DPT
Mailing Address - Street 1:28 MEADOWBROOK DRIVE
Mailing Address - Street 2:
Mailing Address - City:HOWELL
Mailing Address - State:NJ
Mailing Address - Zip Code:07731
Mailing Address - Country:US
Mailing Address - Phone:646-651-0634
Mailing Address - Fax:
Practice Address - Street 1:ATLANTIC PHYSICAL THERAPY CENTER - HOWELL PLAZA
Practice Address - Street 2:4022 US 9
Practice Address - City:HOWELL
Practice Address - State:NJ
Practice Address - Zip Code:07731
Practice Address - Country:US
Practice Address - Phone:732-835-2055
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-02-08
Last Update Date:2019-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0307251225100000X
NJ40QA01433300225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist