Basic Information
| Provider Information | |||||||||
| NPI: | 1437597168 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DELLINGER | ||||||||
| FirstName: | LANA | ||||||||
| MiddleName: | ALDEN | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | DPT | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | POPE | ||||||||
| OtherFirstName: | LANA | ||||||||
| OtherMiddleName: | ALDEN | ||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | DPT | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 101 STILLWATER CIRCLE | ||||||||
| Address2: | |||||||||
| City: | BONAIRE | ||||||||
| State: | GA | ||||||||
| PostalCode: | 31005 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4782931680 | ||||||||
| FaxNumber: | 4782931685 | ||||||||
| Practice Location | |||||||||
| Address1: | 101 STILLWATER CIRCLE | ||||||||
| Address2: | |||||||||
| City: | BONAIRE | ||||||||
| State: | GA | ||||||||
| PostalCode: | 31005 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4782931680 | ||||||||
| FaxNumber: | 4782931685 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/04/2013 | ||||||||
| LastUpdateDate: | 04/26/2016 | ||||||||
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| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
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| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | PT010979 | GA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.