Provider Demographics
NPI:1942207311
Name:HALL, DANIELLE MARIE (PT)
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:MARIE
Last Name:HALL
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 151242
Mailing Address - Street 2:
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33915-1242
Mailing Address - Country:US
Mailing Address - Phone:239-810-1602
Mailing Address - Fax:239-349-3726
Practice Address - Street 1:3728 SE 1ST AVE
Practice Address - Street 2:
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33904-4109
Practice Address - Country:US
Practice Address - Phone:239-810-1602
Practice Address - Fax:239-349-3726
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-30
Last Update Date:2013-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT14801225100000X
WAPT60282951225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLY7715Medicare ID - Type Unspecified