Provider Demographics
NPI:1902972359
Name:BEAVERS, ANA DANIELLE (PT)
Entity Type:Individual
Prefix:MRS
First Name:ANA
Middle Name:DANIELLE
Last Name:BEAVERS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MISS
Other - First Name:ANA
Other - Middle Name:DANIELLE
Other - Last Name:SHENKO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:15217 PLANTATION OAKS DR APT 8
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33647-2183
Mailing Address - Country:US
Mailing Address - Phone:813-972-0448
Mailing Address - Fax:
Practice Address - Street 1:6945 GALL BLVD
Practice Address - Street 2:
Practice Address - City:ZEPHYRHILLS
Practice Address - State:FL
Practice Address - Zip Code:33542-2586
Practice Address - Country:US
Practice Address - Phone:813-788-8516
Practice Address - Fax:813-788-8519
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL22948225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL38261193OtherOTHER INSURANCE