Provider Demographics
NPI:1073937009
Name:BOAZ, DANIELLE (PTA)
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:
Last Name:BOAZ
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:144 N TOUSSAINT ST
Mailing Address - Street 2:
Mailing Address - City:OAK HARBOR
Mailing Address - State:OH
Mailing Address - Zip Code:43449-1312
Mailing Address - Country:US
Mailing Address - Phone:419-707-3076
Mailing Address - Fax:
Practice Address - Street 1:144 N TOUSSAINT ST
Practice Address - Street 2:
Practice Address - City:OAK HARBOR
Practice Address - State:OH
Practice Address - Zip Code:43449-1312
Practice Address - Country:US
Practice Address - Phone:419-707-3076
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-02-11
Last Update Date:2014-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH02600225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant