Provider Demographics
NPI:1861530586
Name:CALTRIDER, DENA SUSAN (MSPT)
Entity type:Individual
Prefix:MRS
First Name:DENA
Middle Name:SUSAN
Last Name:CALTRIDER
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1524 SW GOPHER TRL
Mailing Address - Street 2:
Mailing Address - City:PALM CITY
Mailing Address - State:FL
Mailing Address - Zip Code:34990-2759
Mailing Address - Country:US
Mailing Address - Phone:407-443-3226
Mailing Address - Fax:
Practice Address - Street 1:1525 HERBERT ST UNIT 102-103
Practice Address - Street 2:
Practice Address - City:PORT ORANGE
Practice Address - State:FL
Practice Address - Zip Code:32129-6106
Practice Address - Country:US
Practice Address - Phone:386-756-0424
Practice Address - Fax:386-756-0425
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-02
Last Update Date:2019-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT 21827225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPT21827OtherPHYSICAL THERAPY LICENSE