Provider Demographics
NPI:1588837017
Name:DANHIEUX, DIANE E (PTA)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:E
Last Name:DANHIEUX
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 1:1555 DOUSMAN ST
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54303-3207
Mailing Address - Country:US
Mailing Address - Phone:920-494-4525
Mailing Address - Fax:920-494-6887
Practice Address - Street 1:1555 DOUSMAN ST
Practice Address - Street 2:
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54303-3207
Practice Address - Country:US
Practice Address - Phone:920-494-4525
Practice Address - Fax:920-494-6887
Is Sole Proprietor?:No
Enumeration Date:2008-04-04
Last Update Date:2008-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI40432500Medicaid