Provider Demographics
NPI:1477733616
Name:THOMAS, DANIELLE DENEEN (EMERGENCY MED TECH)
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:DENEEN
Last Name:THOMAS
Suffix:
Gender:F
Credentials:EMERGENCY MED TECH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:174 LEEPER LN
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15043-1098
Mailing Address - Country:US
Mailing Address - Phone:412-519-4566
Mailing Address - Fax:
Practice Address - Street 1:3420 MAIN ST
Practice Address - Street 2:
Practice Address - City:WEIRTON
Practice Address - State:WV
Practice Address - Zip Code:26062-4557
Practice Address - Country:US
Practice Address - Phone:412-519-4566
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-05
Last Update Date:2007-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV2007-2290225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist