Provider Demographics
NPI:1679552384
Name:LIEGL, DANIELLE LEGENDRE (PT)
Entity Type:Individual
Prefix:MRS
First Name:DANIELLE
Middle Name:LEGENDRE
Last Name:LIEGL
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 416495
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02241-6495
Mailing Address - Country:US
Mailing Address - Phone:631-580-5200
Mailing Address - Fax:
Practice Address - Street 1:660 NASSAU PARK BLVD # 26C
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:NJ
Practice Address - Zip Code:08540-5949
Practice Address - Country:US
Practice Address - Phone:609-606-1890
Practice Address - Fax:609-606-1891
Is Sole Proprietor?:No
Enumeration Date:2006-01-11
Last Update Date:2021-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01190700225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist