Provider Demographics
NPI:1417116179
Name:THOMSON, DANIELLE V (PT)
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:V
Last Name:THOMSON
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 1:25 HIGH ST
Mailing Address - Street 2:
Mailing Address - City:NUTLEY
Mailing Address - State:NJ
Mailing Address - Zip Code:07110-1131
Mailing Address - Country:US
Mailing Address - Phone:973-235-1515
Mailing Address - Fax:973-235-0452
Practice Address - Street 1:25 HIGH ST
Practice Address - Street 2:
Practice Address - City:NUTLEY
Practice Address - State:NJ
Practice Address - Zip Code:07110-1131
Practice Address - Country:US
Practice Address - Phone:973-235-1515
Practice Address - Fax:973-235-0452
Is Sole Proprietor?:No
Enumeration Date:2008-06-06
Last Update Date:2008-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA008474225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ40QA008474OtherPT LICENSE