Provider Demographics
NPI:1528296472
Name:MATHER, DANA CONNER (PT)
Entity type:Individual
Prefix:
First Name:DANA
Middle Name:CONNER
Last Name:MATHER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3751 DAVIS ROAD
Mailing Address - Street 2:
Mailing Address - City:PENN LAIRD
Mailing Address - State:VA
Mailing Address - Zip Code:22846-9654
Mailing Address - Country:US
Mailing Address - Phone:540-574-1858
Mailing Address - Fax:
Practice Address - Street 1:3751 DAVIS RD
Practice Address - Street 2:
Practice Address - City:PENN LAIRD
Practice Address - State:VA
Practice Address - Zip Code:22846-9654
Practice Address - Country:US
Practice Address - Phone:540-574-1858
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-30
Last Update Date:2009-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305006126225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA2305006126Other2305006126 COMMONWEALTH OF VA PHYSICAL THERAPIST LISCENSE NUMBER