Provider Demographics
NPI:1376931964
Name:HALZACK, DANIELLE ANNE (DPT)
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:ANNE
Last Name:HALZACK
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 1:83 LACKAWANNA AVE APT 83E
Mailing Address - Street 2:
Mailing Address - City:WALLINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07057-2047
Mailing Address - Country:US
Mailing Address - Phone:845-741-6327
Mailing Address - Fax:
Practice Address - Street 1:83 LACKAWANNA AVE APT 83E
Practice Address - Street 2:
Practice Address - City:WALLINGTON
Practice Address - State:NJ
Practice Address - Zip Code:07057-2047
Practice Address - Country:US
Practice Address - Phone:845-741-6327
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-05
Last Update Date:2022-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist