Provider Demographics
NPI:1538501424
Name:LICARI, DANIELLE HELENE (PT)
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:HELENE
Last Name:LICARI
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:DANIELLE
Other - Middle Name:HELENE
Other - Last Name:GILLIATT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:1476 LONG GROVE DR
Mailing Address - Street 2:
Mailing Address - City:MT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29464-7571
Mailing Address - Country:US
Mailing Address - Phone:843-216-3534
Mailing Address - Fax:843-216-3576
Practice Address - Street 1:1476 LONG GROVE DR
Practice Address - Street 2:
Practice Address - City:MT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464-7571
Practice Address - Country:US
Practice Address - Phone:843-216-3534
Practice Address - Fax:843-216-3576
Is Sole Proprietor?:No
Enumeration Date:2013-07-22
Last Update Date:2015-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC5017225100000X
2251G0304X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatrics