Basic Information
| Provider Information | |||||||||
| NPI: | 1063852267 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PANKO | ||||||||
| FirstName: | DAWNA | ||||||||
| MiddleName: | A | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | ATC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 830 THOMAS MORE PKWY | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | EDGEWOOD | ||||||||
| State: | KY | ||||||||
| PostalCode: | 410175102 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8593015600 | ||||||||
| FaxNumber: | 8593015669 | ||||||||
| Practice Location | |||||||||
| Address1: | 830 THOMAS MORE PKWY | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | EDGEWOOD | ||||||||
| State: | KY | ||||||||
| PostalCode: | 410175102 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8593015600 | ||||||||
| FaxNumber: | 8593015669 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/02/2013 | ||||||||
| LastUpdateDate: | 07/02/2013 | ||||||||
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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 | 2255A2300X | AT331 | KY | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Specialist/Technologist | Athletic Trainer |
No ID Information.