Provider Demographics
NPI:1003275629
Name:RUTHVEN, DANIELLE M (PTA)
Entity type:Individual
Prefix:
First Name:DANIELLE
Middle Name:M
Last Name:RUTHVEN
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:DANIELLE
Other - Middle Name:
Other - Last Name:ESMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:20000 VICTOR PKWY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48152-7029
Mailing Address - Country:US
Mailing Address - Phone:734-953-1745
Mailing Address - Fax:734-953-1743
Practice Address - Street 1:15500 19 MILE RD STE 330
Practice Address - Street 2:
Practice Address - City:CLINTON TWP
Practice Address - State:MI
Practice Address - Zip Code:48038-6313
Practice Address - Country:US
Practice Address - Phone:586-412-0016
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-02-11
Last Update Date:2019-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5502004829225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant