Provider Demographics
NPI:1700076163
Name:MERKEL, DANA MICHELLE (PTA)
Entity Type:Individual
Prefix:MRS
First Name:DANA
Middle Name:MICHELLE
Last Name:MERKEL
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 1:201 S SANTINE RD
Mailing Address - Street 2:
Mailing Address - City:CELESTINE
Mailing Address - State:IN
Mailing Address - Zip Code:47521-9703
Mailing Address - Country:US
Mailing Address - Phone:812-482-2103
Mailing Address - Fax:
Practice Address - Street 1:712 W 2ND ST
Practice Address - Street 2:
Practice Address - City:LEAVENWORTH
Practice Address - State:IN
Practice Address - Zip Code:47137-2264
Practice Address - Country:US
Practice Address - Phone:812-739-2292
Practice Address - Fax:812-739-4756
Is Sole Proprietor?:No
Enumeration Date:2007-07-31
Last Update Date:2007-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN06001661A225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant