Provider Demographics
NPI:1649245424
Name:IVENS, DANIELLE QUATIE (MSPT)
Entity Type:Individual
Prefix:MRS
First Name:DANIELLE
Middle Name:QUATIE
Last Name:IVENS
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 MIRANDA WAY
Mailing Address - Street 2:
Mailing Address - City:BRIDGEWATER
Mailing Address - State:MA
Mailing Address - Zip Code:02324-1481
Mailing Address - Country:US
Mailing Address - Phone:508-697-3520
Mailing Address - Fax:
Practice Address - Street 1:150 EMORY ST
Practice Address - Street 2:
Practice Address - City:ATTLEBORO
Practice Address - State:MA
Practice Address - Zip Code:02703-2439
Practice Address - Country:US
Practice Address - Phone:508-222-5800
Practice Address - Fax:508-222-6170
Is Sole Proprietor?:No
Enumeration Date:2006-02-23
Last Update Date:2009-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA15955225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist