Healthcare Provider Details

I. General information

NPI: 1932563665
Provider Name (Legal Business Name): DANIELLE YOUNG
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/08/2016
Last Update Date: 04/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 POND ST
BRAINTREE MA
02184-5351
US

IV. Provider business mailing address

30 WINDSOR DR
WHITMAN MA
02382-1050
US

V. Phone/Fax

Practice location:
  • Phone: 781-348-2482
  • Fax:
Mailing address:
  • Phone: 781-254-6162
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code283X00000X
TaxonomyRehabilitation Hospital
License NumberRN2286294
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: