Provider Demographics
NPI:1457815110
Name:DANLEY, BRITTANY NICHOLE ANDERSON
Entity Type:Individual
Prefix:
First Name:BRITTANY
Middle Name:NICHOLE ANDERSON
Last Name:DANLEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 MODOC CT
Mailing Address - Street 2:
Mailing Address - City:WALESKA
Mailing Address - State:GA
Mailing Address - Zip Code:30183-3807
Mailing Address - Country:US
Mailing Address - Phone:678-446-4874
Mailing Address - Fax:
Practice Address - Street 1:105 MODOC CT
Practice Address - Street 2:
Practice Address - City:WALESKA
Practice Address - State:GA
Practice Address - Zip Code:30183-3807
Practice Address - Country:US
Practice Address - Phone:678-446-4874
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-28
Last Update Date:2019-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA5710225200000X
GAPTA003674225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant