Provider Demographics
NPI:1053359273
Name:BROGNANO, DAWN A (PT)
Entity type:Individual
Prefix:
First Name:DAWN
Middle Name:A
Last Name:BROGNANO
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:728 N FERDON BLVD
Mailing Address - Street 2:STE 3
Mailing Address - City:CRESTVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:32536-2166
Mailing Address - Country:US
Mailing Address - Phone:850-897-3334
Mailing Address - Fax:850-897-7855
Practice Address - Street 1:1950 BLUEWATER BLVD
Practice Address - Street 2:SUITE 101
Practice Address - City:NICEVILLE
Practice Address - State:FL
Practice Address - Zip Code:32578-3888
Practice Address - Country:US
Practice Address - Phone:850-897-3334
Practice Address - Fax:850-897-7855
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-02
Last Update Date:2019-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT21724225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLY906WOtherBCBSFL GROUP#
FL891321800Medicaid