Provider Demographics
NPI:1144407792
Name:TRICE, DANIELA ANDREA (PT)
Entity Type:Individual
Prefix:
First Name:DANIELA
Middle Name:ANDREA
Last Name:TRICE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:DANIELA
Other - Middle Name:ANDREA
Other - Last Name:VILLEGAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10338 BARRINGTON PL
Mailing Address - Street 2:
Mailing Address - City:NEWBURGH
Mailing Address - State:IN
Mailing Address - Zip Code:47630-8748
Mailing Address - Country:US
Mailing Address - Phone:502-807-7745
Mailing Address - Fax:
Practice Address - Street 1:1449 KIMBER LN STE 103A
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47715-4067
Practice Address - Country:US
Practice Address - Phone:124-015-2108
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-25
Last Update Date:2019-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05012861A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist