Provider Demographics
NPI:1306528880
Name:DAMJANOVIC, IRINA IOANA (DPT)
Entity type:Individual
Prefix:
First Name:IRINA
Middle Name:IOANA
Last Name:DAMJANOVIC
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:IRINA
Other - Middle Name:IOANA
Other - Last Name:IACOB
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:105 MARINER HEALTH WAY STE 213
Mailing Address - Street 2:
Mailing Address - City:SAINT AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32086-3251
Mailing Address - Country:US
Mailing Address - Phone:904-217-4259
Mailing Address - Fax:904-217-4251
Practice Address - Street 1:105 MARINER HEALTH WAY STE 213
Practice Address - Street 2:
Practice Address - City:SAINT AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32086-3251
Practice Address - Country:US
Practice Address - Phone:904-217-4259
Practice Address - Fax:904-217-4251
Is Sole Proprietor?:No
Enumeration Date:2023-08-03
Last Update Date:2025-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT40331225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPT40331OtherFLORIDA DEPARTMENT OF HEALTH