Provider Demographics
NPI:1003640947
Name:BOLIN, DANIELLE (PT,DPT)
Entity type:Individual
Prefix:
First Name:DANIELLE
Middle Name:
Last Name:BOLIN
Suffix:
Gender:F
Credentials:PT,DPT
Other - Prefix:
Other - First Name:DANIELLE
Other - Middle Name:
Other - Last Name:IMEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT,DPT
Mailing Address - Street 1:1932 SHAWNEE DR
Mailing Address - Street 2:
Mailing Address - City:SIDNEY
Mailing Address - State:OH
Mailing Address - Zip Code:45365-3505
Mailing Address - Country:US
Mailing Address - Phone:419-790-4682
Mailing Address - Fax:
Practice Address - Street 1:2535 FORT AMANDA RD
Practice Address - Street 2:
Practice Address - City:LIMA
Practice Address - State:OH
Practice Address - Zip Code:45804-3728
Practice Address - Country:US
Practice Address - Phone:419-999-2055
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-30
Last Update Date:2024-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT021293225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist