Healthcare Provider Details

I. General information

NPI: 1912773011
Provider Name (Legal Business Name): DANIELLE ETCHBERGER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/29/2023
Last Update Date: 11/29/2023
Certification Date: 11/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1010 DELAFIELD RD
PITTSBURGH PA
15215-1802
US

IV. Provider business mailing address

100 ELIZABETH DR APT 1209
PITTSBURGH PA
15220-3344
US

V. Phone/Fax

Practice location:
  • Phone: 412-822-1382
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Y00000X
TaxonomyClinical Exercise Physiologist
License Number1061820
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: