Provider Demographics
NPI:1467476705
Name:DOUGLASS, DANA S (PHYSICAL THERAPIST)
Entity type:Individual
Prefix:MISS
First Name:DANA
Middle Name:S
Last Name:DOUGLASS
Suffix:
Gender:F
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:14201 N HAYDEN RD
Mailing Address - Street 2:STE B2
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85260-2931
Mailing Address - Country:US
Mailing Address - Phone:480-268-9078
Mailing Address - Fax:480-275-7134
Practice Address - Street 1:14201 N HAYDEN RD
Practice Address - Street 2:STE B2
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85260-2931
Practice Address - Country:US
Practice Address - Phone:480-268-9078
Practice Address - Fax:480-275-7134
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2013-09-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ29972251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
104572Medicare UPIN