Provider Demographics
NPI:1649446956
Name:MITTERANDO KANSKI, DANIELLE (ATC)
Entity type:Individual
Prefix:MRS
First Name:DANIELLE
Middle Name:
Last Name:MITTERANDO KANSKI
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:DANIELLE
Other - Middle Name:
Other - Last Name:MITTERANDO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ATC
Mailing Address - Street 1:63 TINDALL RD
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07748-2723
Mailing Address - Country:US
Mailing Address - Phone:732-706-6061
Mailing Address - Fax:732-706-9575
Practice Address - Street 1:63 TINDALL RD
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:NJ
Practice Address - Zip Code:07748-2723
Practice Address - Country:US
Practice Address - Phone:732-706-6061
Practice Address - Fax:732-706-9575
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-06
Last Update Date:2008-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MT000600002255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer