Provider Demographics
NPI:1902264930
Name:MCINTIRE, DEANNA LYNNE (PT)
Entity Type:Individual
Prefix:
First Name:DEANNA
Middle Name:LYNNE
Last Name:MCINTIRE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3976 MILLINGTON RD
Mailing Address - Street 2:
Mailing Address - City:FREE UNION
Mailing Address - State:VA
Mailing Address - Zip Code:22940-2103
Mailing Address - Country:US
Mailing Address - Phone:434-293-8221
Mailing Address - Fax:
Practice Address - Street 1:3976 MILLINGTON RD
Practice Address - Street 2:
Practice Address - City:FREE UNION
Practice Address - State:VA
Practice Address - Zip Code:22940-2103
Practice Address - Country:US
Practice Address - Phone:434-293-8221
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-04
Last Update Date:2016-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305006579225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist