Provider Demographics
NPI:1619252731
Name:CULLEN, DANIELLE R (MPT)
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:R
Last Name:CULLEN
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2613 GROUSE HOLLOW WAY
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:TX
Mailing Address - Zip Code:76065-5988
Mailing Address - Country:US
Mailing Address - Phone:314-322-1511
Mailing Address - Fax:
Practice Address - Street 1:2613 GROUSE HOLLOW WAY
Practice Address - Street 2:
Practice Address - City:MIDLOTHIAN
Practice Address - State:TX
Practice Address - Zip Code:76065-5988
Practice Address - Country:US
Practice Address - Phone:314-322-1511
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-20
Last Update Date:2021-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1230867225100000X
MO2002007673225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO150900047Medicare PIN