Provider Demographics
NPI:1366221558
Name:KETAY, DANIELA
Entity type:Individual
Prefix:MS
First Name:DANIELA
Middle Name:
Last Name:KETAY
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 1:28260 PINE HAVEN WAY APT 82
Mailing Address - Street 2:
Mailing Address - City:BONITA SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:34135-2823
Mailing Address - Country:US
Mailing Address - Phone:239-241-3083
Mailing Address - Fax:239-241-3083
Practice Address - Street 1:28260 PINE HAVEN WAY APT 82
Practice Address - Street 2:
Practice Address - City:BONITA SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:34135-2823
Practice Address - Country:US
Practice Address - Phone:239-241-3083
Practice Address - Fax:239-241-3083
Is Sole Proprietor?:No
Enumeration Date:2023-09-26
Last Update Date:2023-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA84207225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist