Provider Demographics
NPI:1235420910
Name:JWANOUSKOS, DANIELLE KATHLEEN (DPT)
Entity Type:Individual
Prefix:MS
First Name:DANIELLE
Middle Name:KATHLEEN
Last Name:JWANOUSKOS
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15382 FREEDOM DR N
Mailing Address - Street 2:
Mailing Address - City:HUG
Mailing Address - State:MN
Mailing Address - Zip Code:55038
Mailing Address - Country:US
Mailing Address - Phone:651-216-2968
Mailing Address - Fax:
Practice Address - Street 1:4050 COON RAPIDS BLVD NW
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55433-2522
Practice Address - Country:US
Practice Address - Phone:763-236-9812
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-28
Last Update Date:2011-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist