Provider Demographics
NPI:1659433894
Name:JARVIS, DANIELLE S (RPT)
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:S
Last Name:JARVIS
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11337 VALLEY HEIGHTS CIR
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83709-6645
Mailing Address - Country:US
Mailing Address - Phone:208-562-0447
Mailing Address - Fax:
Practice Address - Street 1:448 S MAPLE GROVE RD
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83709
Practice Address - Country:US
Practice Address - Phone:208-859-9953
Practice Address - Fax:208-629-3155
Is Sole Proprietor?:No
Enumeration Date:2006-12-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDPT863225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IDTD450OtherBLUE CROSS
ID000010154466OtherBLUE SHIELD
ID1651072Medicare ID - Type Unspecified