Provider Demographics
NPI:1396093761
Name:DOUGLAS, DANA J (LMT)
Entity type:Individual
Prefix:
First Name:DANA
Middle Name:J
Last Name:DOUGLAS
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1526 N ATHERTON ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:STATE COLLEGE
Mailing Address - State:PA
Mailing Address - Zip Code:16803-3041
Mailing Address - Country:US
Mailing Address - Phone:814-237-5220
Mailing Address - Fax:814-237-5251
Practice Address - Street 1:1526 N ATHERTON ST
Practice Address - Street 2:SUITE 200
Practice Address - City:STATE COLLEGE
Practice Address - State:PA
Practice Address - Zip Code:16803-3041
Practice Address - Country:US
Practice Address - Phone:814-237-5220
Practice Address - Fax:814-237-5251
Is Sole Proprietor?:No
Enumeration Date:2012-08-16
Last Update Date:2012-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMSG001509225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist