Provider Demographics
NPI:1336455104
Name:VERNON, DIONNE OKOLO LISA (DPT)
Entity type:Individual
Prefix:
First Name:DIONNE
Middle Name:OKOLO LISA
Last Name:VERNON
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 1:10095 W OAKLAND PARK BLVD
Mailing Address - Street 2:
Mailing Address - City:SUNRISE
Mailing Address - State:FL
Mailing Address - Zip Code:33351-6919
Mailing Address - Country:US
Mailing Address - Phone:717-409-7910
Mailing Address - Fax:717-635-4836
Practice Address - Street 1:10095 W OAKLAND PARK BLVD
Practice Address - Street 2:
Practice Address - City:SUNRISE
Practice Address - State:FL
Practice Address - Zip Code:33351-6919
Practice Address - Country:US
Practice Address - Phone:717-409-7910
Practice Address - Fax:717-635-4836
Is Sole Proprietor?:No
Enumeration Date:2010-08-31
Last Update Date:2024-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ225100000X
FLPT34256225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist