Basic Information
| Provider Information | |||||||||
| NPI: | 1275688806 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GOLDSTEIN | ||||||||
| FirstName: | DANIELLE | ||||||||
| MiddleName: | LAURIE | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 13946 BALTIMORE AVE | ||||||||
| Address2: | |||||||||
| City: | LAUREL | ||||||||
| State: | MD | ||||||||
| PostalCode: | 207075000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3014982212 | ||||||||
| FaxNumber: | 3014982213 | ||||||||
| Practice Location | |||||||||
| Address1: | 13946 BALTIMORE AVE | ||||||||
| Address2: | |||||||||
| City: | LAUREL | ||||||||
| State: | MD | ||||||||
| PostalCode: | 207075000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3014982212 | ||||||||
| FaxNumber: | 3014982213 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/24/2007 | ||||||||
| LastUpdateDate: | 03/19/2012 | ||||||||
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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 | 19695 | MD | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | KBX | 01 | MD | BLUE SHIELD MD | OTHER | S429 | 01 | MD | BLUE SHIELD DC | OTHER |