Provider Demographics
NPI:1912254608
Name:REISBAUM, DANIELLE (DPT)
Entity Type:Individual
Prefix:DR
First Name:DANIELLE
Middle Name:
Last Name:REISBAUM
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:463 MCKINLEY ST
Mailing Address - Street 2:
Mailing Address - City:WEST HEMPSTEAD
Mailing Address - State:NY
Mailing Address - Zip Code:11552-2731
Mailing Address - Country:US
Mailing Address - Phone:516-640-5685
Mailing Address - Fax:
Practice Address - Street 1:463 MCKINLEY ST
Practice Address - Street 2:
Practice Address - City:WEST HEMPSTEAD
Practice Address - State:NY
Practice Address - Zip Code:11552-2731
Practice Address - Country:US
Practice Address - Phone:516-640-5685
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-13
Last Update Date:2012-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics