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General NPI Number Information
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NPI Number | 1336234673
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Entity Type | Individual
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Provider Name | ADRIENNE LEE DAISERNIA P.T.
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Gender | Female
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Dates
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Enumeration Date | 10/03/2006
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Last Update Date | 12/02/2014
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Provider Practice Location Address
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Address Line | 120 N RICHARD JACKSON BLVD SUITE 30
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City | PANAMA CITY BEACH
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State | FL
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Zip | 32407-2521
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Country | US
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Telephone | 850-235-6360
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Fax | 850-235-8871
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Provider Business Mailing Address
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Address Line | 11605 SAND CASTLE LN
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City | PANAMA CITY BEACH
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State | FL
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Zip | 32407-4547
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Country | US
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Telephone | 850-532-9051
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT18733
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License Number State | FL
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