| Doctor Name: | MISS DANA ELAINE ETHERIDGE |
| NPI Number: | 1598178006 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | MPT |
| License Number: | 8009 |
| Business Practice Address: | 360 E Enon Rd Yellow Springs, OH - 453871415 |
| Business Phone Number: | 9377671303 |
| Business Fax Number: | 9377671025 |
| Mailing Address: | 360 E Enon Rd, YELLOW SPRINGS |
| State: | OH |
| Postal Code: | 453871415 |
| Phone Number: | 9377671303 |
| Fax Number: | 9377671025 |
| NPI Enumeration Date: | 06/03/2014 |
| NPI Last Update Date: | 06/03/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 2251P0200X |
| License Number: | 8009 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | OH |
| Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Taxonomy Classification: | Physical Therapist |
| Taxonomy Specialization: | Pediatrics |
| Taxonomy Definition: | |