Provider Demographics
NPI:1346496981
Name:ANDREW, DANIELLE LYN (DPT)
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:LYN
Last Name:ANDREW
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5496 E TAFT RD
Mailing Address - Street 2:STE 2
Mailing Address - City:NORTH SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13212-3784
Mailing Address - Country:US
Mailing Address - Phone:315-451-6541
Mailing Address - Fax:315-451-7059
Practice Address - Street 1:792 N MAIN ST
Practice Address - Street 2:STE 100C
Practice Address - City:NORTH SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13212-1644
Practice Address - Country:US
Practice Address - Phone:315-458-2552
Practice Address - Fax:315-458-2575
Is Sole Proprietor?:No
Enumeration Date:2008-08-14
Last Update Date:2010-04-16
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY030489225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYRB9316Medicare PIN