Healthcare Provider Details

I. General information

NPI: 1770908493
Provider Name (Legal Business Name): DANIELLE PAULS LPTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/04/2014
Last Update Date: 02/06/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 N WISCONSIN AVE
MUSCODA WI
53573-9115
US

IV. Provider business mailing address

703 DON JON LN
AVOCA WI
53506-9625
US

V. Phone/Fax

Practice location:
  • Phone: 608-739-3186
  • Fax: 608-739-3486
Mailing address:
  • Phone: 608-475-4462
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number2119-19
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: