Provider Demographics
NPI:1700681590
Name:D'AMICO, ANNA RENE
Entity type:Individual
Prefix:
First Name:ANNA
Middle Name:RENE
Last Name:D'AMICO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:280 TRIPLE CROWN CIR
Mailing Address - Street 2:
Mailing Address - City:SPRINGBORO
Mailing Address - State:OH
Mailing Address - Zip Code:45066-9188
Mailing Address - Country:US
Mailing Address - Phone:937-409-1418
Mailing Address - Fax:
Practice Address - Street 1:280 TRIPLE CROWN CIR
Practice Address - Street 2:
Practice Address - City:SPRINGBORO
Practice Address - State:OH
Practice Address - Zip Code:45066-9188
Practice Address - Country:US
Practice Address - Phone:937-409-1418
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-15
Last Update Date:2025-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer