Healthcare Provider Details

I. General information

NPI: 1295783405
Provider Name (Legal Business Name): DANIELLE MORRIS PT
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/04/2006
Last Update Date: 04/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

UNIT 28038
APO AE
09112
US

IV. Provider business mailing address

CMR 411 BOX 1557
APO AE
09112
US

V. Phone/Fax

Practice location:
  • Phone: 09662833221
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171W00000X
TaxonomyContractor
License NumberPT 20000
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: