Provider Demographics
NPI:1629812565
Name:CHIA, DANIELLE NICOLE (PTA)
Entity type:Individual
Prefix:MRS
First Name:DANIELLE
Middle Name:NICOLE
Last Name:CHIA
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:MISS
Other - First Name:DANIELLE
Other - Middle Name:NICOLE
Other - Last Name:HIATT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:410 MARINGO RD
Mailing Address - Street 2:
Mailing Address - City:EPHRATA
Mailing Address - State:WA
Mailing Address - Zip Code:98823-1580
Mailing Address - Country:US
Mailing Address - Phone:509-289-8256
Mailing Address - Fax:
Practice Address - Street 1:200 NAT WASHINGTON WAY
Practice Address - Street 2:
Practice Address - City:EPHRATA
Practice Address - State:WA
Practice Address - Zip Code:98823-1982
Practice Address - Country:US
Practice Address - Phone:509-754-4631
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-25
Last Update Date:2024-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAP161568470225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant