Provider Demographics
NPI:1669953329
Name:JAEGER, DANIELLE LOREN (DPT)
Entity type:Individual
Prefix:
First Name:DANIELLE
Middle Name:LOREN
Last Name:JAEGER
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:DANIELLE
Other - Middle Name:
Other - Last Name:JAEGER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DPT
Mailing Address - Street 1:W148N7736 MENOMONEE MANOR DR
Mailing Address - Street 2:
Mailing Address - City:MENOMONEE FALLS
Mailing Address - State:WI
Mailing Address - Zip Code:53051-7324
Mailing Address - Country:US
Mailing Address - Phone:262-527-6446
Mailing Address - Fax:
Practice Address - Street 1:2195 N SUMMIT VILLAGE WAY
Practice Address - Street 2:
Practice Address - City:OCONOMOWOC
Practice Address - State:WI
Practice Address - Zip Code:53066-8675
Practice Address - Country:US
Practice Address - Phone:262-567-4662
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-22
Last Update Date:2018-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI14047225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist