Provider Demographics
NPI:1780905547
Name:STURGEON, DANIELLE M (PT)
Entity type:Individual
Prefix:MRS
First Name:DANIELLE
Middle Name:M
Last Name:STURGEON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MISS
Other - First Name:DANIELLE
Other - Middle Name:M
Other - Last Name:WAITE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:21 CARMICHAEL ST STE 101
Mailing Address - Street 2:
Mailing Address - City:ESSEX JUNCTION
Mailing Address - State:VT
Mailing Address - Zip Code:05452-3100
Mailing Address - Country:US
Mailing Address - Phone:802-878-9572
Mailing Address - Fax:802-878-9592
Practice Address - Street 1:21 CARMICHAEL ST STE 101
Practice Address - Street 2:
Practice Address - City:ESSEX JUNCTION
Practice Address - State:VT
Practice Address - Zip Code:05452-3100
Practice Address - Country:US
Practice Address - Phone:802-878-9572
Practice Address - Fax:802-878-9592
Is Sole Proprietor?:No
Enumeration Date:2010-06-16
Last Update Date:2010-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT040.0067002225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1017969Medicaid