Provider Demographics
NPI:1245893593
Name:WUNDERLICH, DANNIELLE PATRICIA (DPT)
Entity type:Individual
Prefix:MRS
First Name:DANNIELLE
Middle Name:PATRICIA
Last Name:WUNDERLICH
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:MS
Other - First Name:DANNIELLE
Other - Middle Name:PATRICIA
Other - Last Name:DOLAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1177 QUAIL CT
Mailing Address - Street 2:
Mailing Address - City:PEWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53072-3790
Mailing Address - Country:US
Mailing Address - Phone:262-695-3057
Mailing Address - Fax:
Practice Address - Street 1:1177 QUAIL CT
Practice Address - Street 2:
Practice Address - City:PEWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53072-3790
Practice Address - Country:US
Practice Address - Phone:262-695-3057
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-22
Last Update Date:2019-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI13365-24225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist