Provider Demographics
NPI:1649616293
Name:MOFFATT, DANIELLE SUE (PT, DPT)
Entity type:Individual
Prefix:DR
First Name:DANIELLE
Middle Name:SUE
Last Name:MOFFATT
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6123 HENWICK LN
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON CITY
Mailing Address - State:MO
Mailing Address - Zip Code:65109-3373
Mailing Address - Country:US
Mailing Address - Phone:573-690-5605
Mailing Address - Fax:
Practice Address - Street 1:812 SAINT MARYS BLVD
Practice Address - Street 2:
Practice Address - City:JEFFERSON CITY
Practice Address - State:MO
Practice Address - Zip Code:65109-1451
Practice Address - Country:US
Practice Address - Phone:573-690-5605
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-21
Last Update Date:2022-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20120235022251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics