Provider Demographics
NPI:1326786328
Name:GREEN, DANIELLE ALICIA (DPT)
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:ALICIA
Last Name:GREEN
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 1:15410 S MOUNTAIN PKWY STE 112
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85044-6691
Mailing Address - Country:US
Mailing Address - Phone:480-689-5534
Mailing Address - Fax:480-706-7997
Practice Address - Street 1:7601 N ORACLE RD STE 101
Practice Address - Street 2:
Practice Address - City:ORO VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:85704-6310
Practice Address - Country:US
Practice Address - Phone:520-293-5551
Practice Address - Fax:520-293-6638
Is Sole Proprietor?:No
Enumeration Date:2022-05-20
Last Update Date:2023-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPT-32350225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist