Healthcare Provider Details

I. General information

NPI: 1568797884
Provider Name (Legal Business Name): ANISHA DRAKE DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ANISHA PAI

II. Dates (important events)

Enumeration Date: 10/04/2009
Last Update Date: 10/20/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1315 NW 21ST AVE STE 3
CHIEFLAND FL
32626-1978
US

IV. Provider business mailing address

PO BOX 518 SUITE C
WILLISTON FL
32696-0518
US

V. Phone/Fax

Practice location:
  • Phone: 352-493-2999
  • Fax: 352-493-0026
Mailing address:
  • Phone: 352-528-0022
  • Fax: 352-528-2878

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT 25021
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: