Basic Information
| Provider Information | |||||||||
| NPI: | 1003073230 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | TITTO | ||||||||
| FirstName: | DAWN | ||||||||
| MiddleName: | M | ||||||||
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| Credential: | PTA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 311 S CYPRESS RD | ||||||||
| Address2: | |||||||||
| City: | POMPANO BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 330607133 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9547817248 | ||||||||
| FaxNumber: | 9547817313 | ||||||||
| Practice Location | |||||||||
| Address1: | 311 S CYPRESS RD | ||||||||
| Address2: | |||||||||
| City: | POMPANO BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 330607133 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9547817248 | ||||||||
| FaxNumber: | 9547817313 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/16/2008 | ||||||||
| LastUpdateDate: | 05/16/2008 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225200000X | PTA9371 | FL | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapy Assistant |
ID Information
| ID | Type | State | Issuer | Description | PTA9371 | 01 | FL | PTA LICENSE NO | OTHER |