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General NPI Number Information
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NPI Number | 1841678455
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Entity Type | Individual
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Provider Name | DANIELLE NICOLE STUMP
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Gender | Female
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Dates
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Enumeration Date | 05/14/2015
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Last Update Date | 05/14/2015
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Provider Practice Location Address
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Address Line | 4550 SHENANDOAH AVE NW
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City | ROANOKE
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State | VA
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Zip | 24017-4749
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Country | US
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Telephone | 540-982-2860
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Fax |
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Provider Business Mailing Address
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Address Line | 10450 LANCASTER RD
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City | BENT MOUNTAIN
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State | VA
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Zip | 24059-2182
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Country | US
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Telephone | 540-309-1412
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 2306603835
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License Number State | VA
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