Provider Demographics
NPI:1265776280
Name:HELLER, DANA SHAUN (PTA)
Entity type:Individual
Prefix:MRS
First Name:DANA
Middle Name:SHAUN
Last Name:HELLER
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 1:609 KINGS ARM CT
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28409-3112
Mailing Address - Country:US
Mailing Address - Phone:330-319-4367
Mailing Address - Fax:
Practice Address - Street 1:1011 PORTERS NECK RD
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28411-9196
Practice Address - Country:US
Practice Address - Phone:910-686-7195
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-15
Last Update Date:2012-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA4390225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant