Provider Demographics
NPI:1073848768
Name:BARNACK, DANIELLE MARIE (DPT)
Entity Type:Individual
Prefix:MRS
First Name:DANIELLE
Middle Name:MARIE
Last Name:BARNACK
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:MISS
Other - First Name:DANIELLE
Other - Middle Name:MARIE
Other - Last Name:LANATA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:300 LONGWOOD AVE
Mailing Address - Street 2:6TH FLOOR FARLEY BUILDING
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02115-5724
Mailing Address - Country:US
Mailing Address - Phone:781-216-3670
Mailing Address - Fax:617-591-4610
Practice Address - Street 1:9 HOPE AVE
Practice Address - Street 2:
Practice Address - City:WALTHAM
Practice Address - State:MA
Practice Address - Zip Code:02453-2741
Practice Address - Country:US
Practice Address - Phone:781-216-3670
Practice Address - Fax:781-216-3694
Is Sole Proprietor?:No
Enumeration Date:2009-10-14
Last Update Date:2016-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA18800225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist