Provider Demographics
NPI:1164883732
Name:EDMONDSON, DANIELLE
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:
Last Name:EDMONDSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:DANIELLE
Other - Middle Name:
Other - Last Name:O'BYRNE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1961 PANDA CT
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:AL
Mailing Address - Zip Code:36832-6909
Mailing Address - Country:US
Mailing Address - Phone:334-759-0450
Mailing Address - Fax:
Practice Address - Street 1:2408 E UNIVERSITY DR
Practice Address - Street 2:SUITE 106
Practice Address - City:AUBURN
Practice Address - State:AL
Practice Address - Zip Code:36830-9403
Practice Address - Country:US
Practice Address - Phone:334-275-4636
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-10
Last Update Date:2016-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPTH7158225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist