Provider Demographics
NPI:1134476039
Name:KELDERMANS, DANIELLE MARIE (PT,DPT,OCS,FAAOMPT)
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:MARIE
Last Name:KELDERMANS
Suffix:
Gender:F
Credentials:PT,DPT,OCS,FAAOMPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4000 WESTGATE DR
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62711-7434
Mailing Address - Country:US
Mailing Address - Phone:217-899-2270
Mailing Address - Fax:217-953-4129
Practice Address - Street 1:4000 WESTGATE DR
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62711-7434
Practice Address - Country:US
Practice Address - Phone:217-899-2270
Practice Address - Fax:217-953-4129
Is Sole Proprietor?:No
Enumeration Date:2012-08-09
Last Update Date:2023-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070.019153225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist