Provider Demographics
NPI:1013413715
Name:BECRAFT, DANIELLE C (LMT)
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:C
Last Name:BECRAFT
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:DANIELLE
Other - Middle Name:C
Other - Last Name:GRIES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMT
Mailing Address - Street 1:175 W B ST
Mailing Address - Street 2:BUILDING J
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OR
Mailing Address - Zip Code:97477
Mailing Address - Country:US
Mailing Address - Phone:541-636-3905
Mailing Address - Fax:541-505-9023
Practice Address - Street 1:175 W B ST
Practice Address - Street 2:BUILDING J
Practice Address - City:SPRINGFIELD
Practice Address - State:OR
Practice Address - Zip Code:97477
Practice Address - Country:US
Practice Address - Phone:541-636-3905
Practice Address - Fax:541-505-9023
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-02
Last Update Date:2019-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR023403225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist