Provider Demographics
NPI:1407919343
Name:GASTINEAU, DANIELE (PT)
Entity Type:Individual
Prefix:MS
First Name:DANIELE
Middle Name:
Last Name:GASTINEAU
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 1:6970 FARM TO MARKET RD
Mailing Address - Street 2:
Mailing Address - City:WHITEFISH
Mailing Address - State:MT
Mailing Address - Zip Code:59937-8303
Mailing Address - Country:US
Mailing Address - Phone:406-261-3472
Mailing Address - Fax:406-862-5600
Practice Address - Street 1:770 W RESERVE DR
Practice Address - Street 2:
Practice Address - City:KALISPELL
Practice Address - State:MT
Practice Address - Zip Code:59901-2130
Practice Address - Country:US
Practice Address - Phone:406-861-3472
Practice Address - Fax:406-862-5600
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-19
Last Update Date:2007-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1644PT225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT61918OtherBLUE CROSS / BLUE SHIELD
MT3400293Medicaid