MEDICARE: CLARA DANZEISEN PT, DPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	PT 30837	FL

General Provider Information

NPI Number	:	1710357413
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CLARA DANZEISEN PT, DPT

Provider Business Mailing Address
First Line	:	6474 RIDGE RD
Second Line	:
City	:	PORT RICHEY
State	:	FL
Zip	:	34668-6748
Country	:	US
Telephone Number	:	727-846-0547
Fax Number	:	727-847-0755

Provider Business Practice Location Address
First Line	:	6474 RIDGE RD
Second Line	:
City	:	PORT RICHEY
State	:	FL
Zip	:	34668-6748
Country	:	US
Telephone Number	:	727-846-0547
Fax Number	:	727-847-0755

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/07/2015
Last Update Date	:	10/07/2015

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