Provider Demographics
NPI:1649391400
Name:STUART, DANIELLE (ATC)
Entity Type:Individual
Prefix:MS
First Name:DANIELLE
Middle Name:
Last Name:STUART
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1627 RIDGE AVE
Mailing Address - Street 2:
Mailing Address - City:CORAOPOLIS
Mailing Address - State:PA
Mailing Address - Zip Code:15108-2123
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:EDINBORO UNIVERSITY OF PA
Practice Address - Street 2:455 SCOTLAND RD
Practice Address - City:EDINBORO
Practice Address - State:PA
Practice Address - Zip Code:16444-0001
Practice Address - Country:US
Practice Address - Phone:814-732-1862
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PART0041142255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer