Provider Demographics
NPI:1558769620
Name:MAXWELL, DANIELLE (LMT, RT)
Entity Type:Individual
Prefix:MISS
First Name:DANIELLE
Middle Name:
Last Name:MAXWELL
Suffix:
Gender:F
Credentials:LMT, RT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2320 W SUMMIT DR
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59803-2622
Mailing Address - Country:US
Mailing Address - Phone:406-531-3588
Mailing Address - Fax:
Practice Address - Street 1:1620 REGENT ST
Practice Address - Street 2:SUITE D
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59801-5676
Practice Address - Country:US
Practice Address - Phone:406-531-3588
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-12-05
Last Update Date:2017-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT4584225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist