Provider Demographics
NPI:1356511299
Name:DANIELSON, MARY (PT)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:DANIELSON
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 1:12565 W CENTER RD STE 130
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68144-3802
Mailing Address - Country:US
Mailing Address - Phone:402-346-7772
Mailing Address - Fax:402-344-6552
Practice Address - Street 1:12565 W CENTER RD STE 130
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68144-3802
Practice Address - Country:US
Practice Address - Phone:402-346-7772
Practice Address - Fax:402-344-6552
Is Sole Proprietor?:No
Enumeration Date:2008-03-06
Last Update Date:2018-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE2104225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist