Provider Demographics
NPI:1033129648
Name:HEINRICHS, DANIELLE P (PT)
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:P
Last Name:HEINRICHS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:DANIELLE
Other - Middle Name:P
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4790 TABLE MESA DRIVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80305
Mailing Address - Country:US
Mailing Address - Phone:303-447-2873
Mailing Address - Fax:303-447-2741
Practice Address - Street 1:4790 TABLE MESA DRIVE
Practice Address - Street 2:SUITE 200 MEDICALLY BASED FITNESS
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80305
Practice Address - Country:US
Practice Address - Phone:303-447-2873
Practice Address - Fax:303-447-2741
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO5718225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
COM445168Medicare ID - Type Unspecified