Provider Demographics
NPI:1952982761
Name:DASCENZO, EMILY DENISE (DPT)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:DENISE
Last Name:DASCENZO
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4579 HARBINSON AVE
Mailing Address - Street 2:
Mailing Address - City:LA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:91942-8764
Mailing Address - Country:US
Mailing Address - Phone:619-607-1386
Mailing Address - Fax:
Practice Address - Street 1:3780 MASSACHUSETTS AVE
Practice Address - Street 2:
Practice Address - City:LA MESA
Practice Address - State:CA
Practice Address - Zip Code:91941-7638
Practice Address - Country:US
Practice Address - Phone:619-465-1313
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-14
Last Update Date:2021-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA40025225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist