Provider Demographics
NPI:1942576590
Name:PIVA, DANYEL LEANN (LMP)
Entity Type:Individual
Prefix:
First Name:DANYEL
Middle Name:LEANN
Last Name:PIVA
Suffix:
Gender:F
Credentials:LMP
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 516
Mailing Address - Street 2:
Mailing Address - City:YACOLT
Mailing Address - State:WA
Mailing Address - Zip Code:98675-0699
Mailing Address - Country:US
Mailing Address - Phone:360-686-0851
Mailing Address - Fax:
Practice Address - Street 1:311 N AMBOY AVE
Practice Address - Street 2:
Practice Address - City:YACOLT
Practice Address - State:WA
Practice Address - Zip Code:98675-5442
Practice Address - Country:US
Practice Address - Phone:360-668-6085
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-28
Last Update Date:2012-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00023512225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist