Healthcare Provider Details

I. General information

NPI: 1730674292
Provider Name (Legal Business Name): DANYKIA CHANDRELLE PERINE PT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/27/2018
Last Update Date: 12/04/2025
Certification Date: 12/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3903 S COBB DR SE STE 275
SMYRNA GA
30080-6455
US

IV. Provider business mailing address

8259 WICKER AVE
SAINT JOHN IN
46373-8878
US

V. Phone/Fax

Practice location:
  • Phone: 404-251-2109
  • Fax:
Mailing address:
  • Phone: 740-275-4480
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberAT001928
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT018117
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: