Provider Demographics
NPI:1841845963
Name:O'BRIEN, DANIELLE (DPT, PT)
Entity type:Individual
Prefix:
First Name:DANIELLE
Middle Name:
Last Name:O'BRIEN
Suffix:
Gender:F
Credentials:DPT, PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:477 N WHITEWATER PARK BLVD APT C302
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83702-5686
Mailing Address - Country:US
Mailing Address - Phone:208-949-4846
Mailing Address - Fax:
Practice Address - Street 1:1673 W SHORELINE DR STE 230
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83702-6752
Practice Address - Country:US
Practice Address - Phone:208-343-4700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-06
Last Update Date:2023-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDPT-6407225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IDPT-6407Medicaid