Provider Demographics
NPI:1336575117
Name:PHILLIPS, DANIELLE MARIE (PT)
Entity Type:Individual
Prefix:MRS
First Name:DANIELLE
Middle Name:MARIE
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MRS
Other - First Name:DANIELLE
Other - Middle Name:MARIE
Other - Last Name:CARDINALE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:917 LILY CREEK ROAD
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40243
Mailing Address - Country:US
Mailing Address - Phone:502-694-9322
Mailing Address - Fax:502-237-7373
Practice Address - Street 1:917 LILY CREEK RD
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40243
Practice Address - Country:US
Practice Address - Phone:502-694-9322
Practice Address - Fax:502-237-7373
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-24
Last Update Date:2023-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY006249225100000X, 208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist