Provider Demographics
NPI:1780939918
Name:HERRICK, DANNA K (DPT)
Entity type:Individual
Prefix:
First Name:DANNA
Middle Name:K
Last Name:HERRICK
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:DANNA
Other - Middle Name:K
Other - Last Name:KELLY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:1905 INGERSOLL AVE
Mailing Address - Street 2:STE. 104
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50309-3305
Mailing Address - Country:US
Mailing Address - Phone:515-369-2306
Mailing Address - Fax:515-369-2307
Practice Address - Street 1:1905 INGERSOLL AVE
Practice Address - Street 2:STE. 104
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50309-3305
Practice Address - Country:US
Practice Address - Phone:515-369-2306
Practice Address - Fax:515-369-2307
Is Sole Proprietor?:No
Enumeration Date:2012-07-13
Last Update Date:2012-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA004997225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist