Provider Demographics
NPI:1447807177
Name:PACYNA, DANIELLE ANDRE (DPT)
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:ANDRE
Last Name:PACYNA
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:DANIELLE
Other - Middle Name:
Other - Last Name:ANDRE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:501 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:OLD FORGE
Mailing Address - State:PA
Mailing Address - Zip Code:18518-1541
Mailing Address - Country:US
Mailing Address - Phone:570-457-4099
Mailing Address - Fax:570-457-7205
Practice Address - Street 1:501 HAMLIN HWY
Practice Address - Street 2:
Practice Address - City:HAMLIN
Practice Address - State:PA
Practice Address - Zip Code:18427-9800
Practice Address - Country:US
Practice Address - Phone:570-689-7786
Practice Address - Fax:570-689-7837
Is Sole Proprietor?:No
Enumeration Date:2019-08-19
Last Update Date:2023-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1033938999Medicaid