Basic Information
| Provider Information | |||||||||
| NPI: | 1083787915 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GREGOIRE | ||||||||
| FirstName: | DANIELLE | ||||||||
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| Credential: | PT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1812 MARSH RD STE 505 | ||||||||
| Address2: | |||||||||
| City: | WILMINGTON | ||||||||
| State: | DE | ||||||||
| PostalCode: | 198104515 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3027930432 | ||||||||
| FaxNumber: | 3027930400 | ||||||||
| Practice Location | |||||||||
| Address1: | 9475 ROOSEVELT BLVD | ||||||||
| Address2: | |||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191142212 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2154646200 | ||||||||
| FaxNumber: | 2154649834 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/16/2006 | ||||||||
| LastUpdateDate: | 03/09/2009 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | PT018268 | PA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | 1083787915 | 01 | CHAMPUS TRICARE | OTHER | 223531 | 01 | PA | PABS | OTHER | 2849800000 | 01 | AMERIHEALTH IBC | OTHER |