Healthcare Provider Details

I. General information

NPI: 1174172464
Provider Name (Legal Business Name): DANIELLE NICOLE DREW DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: DANIELLE NICOLE PUCKETT DPT

II. Dates (important events)

Enumeration Date: 09/09/2019
Last Update Date: 09/17/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3460 TORRANCE BLVD STE 100
TORRANCE CA
90503-5812
US

IV. Provider business mailing address

3460 TORRANCE BLVD STE 100
TORRANCE CA
90503-5812
US

V. Phone/Fax

Practice location:
  • Phone: 310-371-8555
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT018945
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number4896
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: