Basic Information
| Provider Information | |||||||||
| NPI: | 1063401529 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ILLFELDER | ||||||||
| FirstName: | DANIELLE | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | PT, DPT, MSPT | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | VOLK | ||||||||
| OtherFirstName: | DANIELLE | ||||||||
| OtherMiddleName: | LAUREN | ||||||||
| OtherNamePrefix: | MRS. | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | DPT | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 263 BROUGHTON LN | ||||||||
| Address2: | |||||||||
| City: | VILLANOVA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 190851913 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6172830634 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 456 SAINT DAVIDS AVE | ||||||||
| Address2: | |||||||||
| City: | WAYNE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 190874203 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6102252451 | ||||||||
| FaxNumber: | 6109646166 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/18/2005 | ||||||||
| LastUpdateDate: | 10/15/2012 | ||||||||
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| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
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| AuthorizedOfficialMiddleName: | |||||||||
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| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 16101 | MA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.