Provider Demographics
NPI:1528357787
Name:FAUGHT, DANIELLE DELILAH (PTA)
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:DELILAH
Last Name:FAUGHT
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:521 SMOKY CROSSING WAY
Mailing Address - Street 2:
Mailing Address - City:SEYMOUR
Mailing Address - State:TN
Mailing Address - Zip Code:37865-5091
Mailing Address - Country:US
Mailing Address - Phone:865-680-5574
Mailing Address - Fax:
Practice Address - Street 1:5539 HWY 47
Practice Address - Street 2:
Practice Address - City:CHASE CITY
Practice Address - State:VA
Practice Address - Zip Code:23924-3727
Practice Address - Country:US
Practice Address - Phone:434-372-8885
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-28
Last Update Date:2011-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2306603003225200000X
TN4706225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant