Provider Demographics
NPI:1376274282
Name:FOGLESONG, DANIELLE LYNN (PTA)
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:LYNN
Last Name:FOGLESONG
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1348 S GOODRICH ST
Mailing Address - Street 2:
Mailing Address - City:COLFAX
Mailing Address - State:IA
Mailing Address - Zip Code:50054-7555
Mailing Address - Country:US
Mailing Address - Phone:641-660-9723
Mailing Address - Fax:
Practice Address - Street 1:500 1ST ST N
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:IA
Practice Address - Zip Code:50208-3119
Practice Address - Country:US
Practice Address - Phone:641-791-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-21
Last Update Date:2022-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA001180225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant