Healthcare Provider Details

I. General information

NPI: 1164492047
Provider Name (Legal Business Name): DANIELLE RENEE FRIEDLEIN PT, ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DANIELLE RENEE JURJEVICH

II. Dates (important events)

Enumeration Date: 01/24/2006
Last Update Date: 01/25/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1307 S BROADWAY ST
TOLEDO IA
52342-2307
US

IV. Provider business mailing address

1307 S BROADWAY ST
TOLEDO IA
52342-2307
US

V. Phone/Fax

Practice location:
  • Phone: 641-484-5253
  • Fax:
Mailing address:
  • Phone: 641-484-5253
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number03538
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number00322
License Number StateIA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier035276
Identifier TypeOTHER
Identifier StateIA
Identifier IssuerBLUE CROSS BLUE SHIELD
# 2
Identifier0433441
Identifier TypeMEDICAID
Identifier StateIA
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: