=====================================================
General NPI Number Information
=====================================================
NPI Number | 1962649277
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DANA LEANN PERAULT P.T.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/09/2009
-----------------------------------------------------
Last Update Date | 01/09/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1900 TATE SPRINGS RD SUITE 16
-----------------------------------------------------
City | LYNCHBURG
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 24501-1122
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 434-200-5407
-----------------------------------------------------
Fax | 434-200-7646
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1445 NELSON DR
-----------------------------------------------------
City | LYNCHBURG
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 24502-2051
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 434-239-2239
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | 2305006591
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------