Basic Information
| Provider Information | |||||||||
| NPI: | 1568720100 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FOGUS | ||||||||
| FirstName: | DANIELLE | ||||||||
| MiddleName: | J | ||||||||
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| Credential: | PT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3451 S CHAMBERS RD | ||||||||
| Address2: | SUITE 1020 | ||||||||
| City: | AURORA | ||||||||
| State: | CO | ||||||||
| PostalCode: | 800145073 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3036806121 | ||||||||
| FaxNumber: | 3036806827 | ||||||||
| Practice Location | |||||||||
| Address1: | 3451 S CHAMBERS RD | ||||||||
| Address2: | SUITE 1020 | ||||||||
| City: | AURORA | ||||||||
| State: | CO | ||||||||
| PostalCode: | 800145073 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3036806121 | ||||||||
| FaxNumber: | 3036806827 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/02/2012 | ||||||||
| LastUpdateDate: | 05/10/2017 | ||||||||
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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 | PTL.0014450 | CO | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.