Provider Demographics
NPI:1679296461
Name:DENCH, DANIELLE AILEEN (PTA)
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:AILEEN
Last Name:DENCH
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:DANIELLE
Other - Middle Name:AILEEN
Other - Last Name:RICHARDSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:14 WESLEY ST
Mailing Address - Street 2:
Mailing Address - City:CENTER MORICHES
Mailing Address - State:NY
Mailing Address - Zip Code:11934-3718
Mailing Address - Country:US
Mailing Address - Phone:631-495-5354
Mailing Address - Fax:
Practice Address - Street 1:NEW YORK THERAPY PLACEMENT SERVICES, INC.
Practice Address - Street 2:299 HALLOCK AVENUE
Practice Address - City:PORT JEFFERSON STATION
Practice Address - State:NY
Practice Address - Zip Code:11776
Practice Address - Country:US
Practice Address - Phone:631-331-2204
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-26
Last Update Date:2022-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1774345225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1774345OtherPHYSICAL THERAPIST ASSISTANT LICENSE