Provider Demographics
NPI:1740209634
Name:BAUMAN, DANIELLA ANNE (PT)
Entity Type:Individual
Prefix:MRS
First Name:DANIELLA
Middle Name:ANNE
Last Name:BAUMAN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MS
Other - First Name:DANIELLA
Other - Middle Name:A
Other - Last Name:COLEMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:1113 77TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11228-2335
Mailing Address - Country:US
Mailing Address - Phone:718-745-8282
Mailing Address - Fax:718-745-4394
Practice Address - Street 1:7410 11TH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11228-1942
Practice Address - Country:US
Practice Address - Phone:718-745-8282
Practice Address - Fax:718-745-4394
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2011-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012423225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQP7921Medicare ID - Type UnspecifiedPHYSICAL THERAPY