Provider Demographics
NPI:1184650384
Name:HALSTED, DANIELLE (PT)
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:
Last Name:HALSTED
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:631C NATIONAL PIKE E
Mailing Address - Street 2:
Mailing Address - City:BROWNSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15417-9603
Mailing Address - Country:US
Mailing Address - Phone:724-785-5262
Mailing Address - Fax:724-785-5561
Practice Address - Street 1:631C NATIONAL PIKE E
Practice Address - Street 2:
Practice Address - City:BROWNSVILLE
Practice Address - State:PA
Practice Address - Zip Code:15417-9603
Practice Address - Country:US
Practice Address - Phone:724-785-5262
Practice Address - Fax:724-785-5561
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT017435225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0015935850015Medicaid
PA0015935850015Medicaid