Provider Demographics
NPI:1972869089
Name:WHITCOMB, DANIELLE R (LPTA)
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:R
Last Name:WHITCOMB
Suffix:
Gender:F
Credentials:LPTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:119 PISGAH RD
Mailing Address - Street 2:
Mailing Address - City:SHERMANS DALE
Mailing Address - State:PA
Mailing Address - Zip Code:17090-8845
Mailing Address - Country:US
Mailing Address - Phone:717-576-8823
Mailing Address - Fax:
Practice Address - Street 1:111 W JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32801-1809
Practice Address - Country:US
Practice Address - Phone:717-576-8823
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-03
Last Update Date:2012-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PATE008817225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant