Provider Demographics
NPI:1881475077
Name:NAHRA, DANIELLE (PTA)
Entity type:Individual
Prefix:
First Name:DANIELLE
Middle Name:
Last Name:NAHRA
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4929 PLEASANT ST APT 105
Mailing Address - Street 2:
Mailing Address - City:WEST DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50266-5467
Mailing Address - Country:US
Mailing Address - Phone:712-454-9441
Mailing Address - Fax:
Practice Address - Street 1:9225 CASCADE AVE
Practice Address - Street 2:
Practice Address - City:WEST DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50266-8592
Practice Address - Country:US
Practice Address - Phone:515-978-2395
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-12
Last Update Date:2023-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA120565225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant