Provider Demographics
NPI:1669777827
Name:TARANTINO, DANNIELLE (LMBT)
Entity type:Individual
Prefix:
First Name:DANNIELLE
Middle Name:
Last Name:TARANTINO
Suffix:
Gender:F
Credentials:LMBT
Other - Prefix:
Other - First Name:DEE
Other - Middle Name:
Other - Last Name:TARANTINO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMBT
Mailing Address - Street 1:PO BOX 1794
Mailing Address - Street 2:
Mailing Address - City:PITTSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27312-1788
Mailing Address - Country:US
Mailing Address - Phone:919-260-1740
Mailing Address - Fax:
Practice Address - Street 1:358 EAST ST
Practice Address - Street 2:
Practice Address - City:PITTSBORO
Practice Address - State:NC
Practice Address - Zip Code:27312-9722
Practice Address - Country:US
Practice Address - Phone:919-542-1557
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-20
Last Update Date:2011-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC6104225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist