Provider Demographics
NPI:1003473786
Name:IVIE, DANIELLE BUCHANAN (DPT)
Entity Type:Individual
Prefix:DR
First Name:DANIELLE
Middle Name:BUCHANAN
Last Name:IVIE
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:4444 FOREST PARK AVE
Mailing Address - Street 2:CB 8502
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63108-2212
Mailing Address - Country:US
Mailing Address - Phone:314-286-1940
Mailing Address - Fax:314-286-1473
Practice Address - Street 1:4444 FOREST PARK AVE
Practice Address - Street 2:STE 1210
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63108-2212
Practice Address - Country:US
Practice Address - Phone:314-286-1940
Practice Address - Fax:314-286-1473
Is Sole Proprietor?:No
Enumeration Date:2019-05-28
Last Update Date:2021-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2019017284225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist