Provider Demographics
NPI:1023525268
Name:WATERS, DANIELLE BRIANNA (DPY)
Entity type:Individual
Prefix:
First Name:DANIELLE
Middle Name:BRIANNA
Last Name:WATERS
Suffix:
Gender:F
Credentials:DPY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1103 W LINE ST
Mailing Address - Street 2:
Mailing Address - City:PALMYRA
Mailing Address - State:MO
Mailing Address - Zip Code:63461-1827
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:872 COLLEGE BLVD
Practice Address - Street 2:
Practice Address - City:OSAGE BEACH
Practice Address - State:MO
Practice Address - Zip Code:65065-8408
Practice Address - Country:US
Practice Address - Phone:573-302-0900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-09
Last Update Date:2022-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2015039522225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist