Provider Demographics
NPI:1487826566
Name:MCRAE, DANIELLE V (DPT)
Entity Type:Individual
Prefix:MS
First Name:DANIELLE
Middle Name:V
Last Name:MCRAE
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2820 HEARNE AVE
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71103-3934
Mailing Address - Country:US
Mailing Address - Phone:318-631-7999
Mailing Address - Fax:318-635-7689
Practice Address - Street 1:2120 BERT KOUNS LOOP
Practice Address - Street 2:SUITE B
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71118-3351
Practice Address - Country:US
Practice Address - Phone:318-687-4156
Practice Address - Fax:318-687-9755
Is Sole Proprietor?:No
Enumeration Date:2008-03-28
Last Update Date:2008-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA073492251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic