Provider Demographics
NPI:1124378070
Name:VAILES, DANIELLE L (MED, ATC, LAT, CES)
Entity Type:Individual
Prefix:MS
First Name:DANIELLE
Middle Name:L
Last Name:VAILES
Suffix:
Gender:F
Credentials:MED, ATC, LAT, CES
Other - Prefix:
Other - First Name:DANIELLE
Other - Middle Name:L
Other - Last Name:CHESNUT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7385 PARK VILLAGE DR APT 2405
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256-8025
Mailing Address - Country:US
Mailing Address - Phone:518-813-0711
Mailing Address - Fax:
Practice Address - Street 1:2800 UNIVERSITY BLVD N
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32211-3321
Practice Address - Country:US
Practice Address - Phone:518-813-0711
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-18
Last Update Date:2021-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAT0019132255A2300X
AL13442255A2300X
FLAL33372255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer