Provider Demographics
NPI:1588799050
Name:CARROLL, DANIELLE A
Entity type:Individual
Prefix:
First Name:DANIELLE
Middle Name:A
Last Name:CARROLL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2101 N TWYMAN RD
Mailing Address - Street 2:
Mailing Address - City:INDEPENDENCE
Mailing Address - State:MO
Mailing Address - Zip Code:64058-3200
Mailing Address - Country:US
Mailing Address - Phone:816-650-7332
Mailing Address - Fax:816-650-7485
Practice Address - Street 1:2101 N TWYMAN RD
Practice Address - Street 2:FORT OSAGE R-I SCHOOL DISTRICT
Practice Address - City:INDEPENDENCE
Practice Address - State:MO
Practice Address - Zip Code:64058-3200
Practice Address - Country:US
Practice Address - Phone:816-650-7332
Practice Address - Fax:816-650-7485
Is Sole Proprietor?:No
Enumeration Date:2007-02-23
Last Update Date:2009-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO1999142847225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO484690425Medicaid