Provider Demographics
NPI:1063740975
Name:DAILEY, ENNEA SELENE (MPT,DPT)
Entity type:Individual
Prefix:DR
First Name:ENNEA
Middle Name:SELENE
Last Name:DAILEY
Suffix:
Gender:F
Credentials:MPT,DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CMR 480 BOX 2376
Mailing Address - Street 2:
Mailing Address - City:APO
Mailing Address - State:AE
Mailing Address - Zip Code:09128-0024
Mailing Address - Country:US
Mailing Address - Phone:407112-070-8070
Mailing Address - Fax:
Practice Address - Street 1:CMR 480 BOX 2376
Practice Address - Street 2:
Practice Address - City:APO
Practice Address - State:AE
Practice Address - Zip Code:09128-0024
Practice Address - Country:US
Practice Address - Phone:407112-070-8070
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-04
Last Update Date:2009-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT1304225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist