Provider Demographics
NPI:1417976663
Name:JOHANSEN, DANIELLE G (PT)
Entity Type:Individual
Prefix:MRS
First Name:DANIELLE
Middle Name:G
Last Name:JOHANSEN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MISS
Other - First Name:DANIELLE
Other - Middle Name:L
Other - Last Name:GERARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:19613 FOXCROFT CIR
Mailing Address - Street 2:
Mailing Address - City:HAGERSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21742-2507
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:19613 FOXCROFT CIR
Practice Address - Street 2:
Practice Address - City:HAGERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21742-2507
Practice Address - Country:US
Practice Address - Phone:301-797-9240
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2008-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD20816225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD7669448OtherAETNA NONHMO
MD1868828OtherAETNA HMO
MD61813504OtherBLUE SHIELD-PPN
MDW2660019OtherBLUE SHIELD GHMI
MD7669448OtherAETNA NONHMO