Basic Information
| Provider Information | |||||||||
| NPI: | 1679904478 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | AXTELL | ||||||||
| FirstName: | DANIELLE | ||||||||
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| Credential: | DPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 181 S 333RD ST | ||||||||
| Address2: | SUITE 250 | ||||||||
| City: | FEDERAL WAY | ||||||||
| State: | WA | ||||||||
| PostalCode: | 980037363 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2538743140 | ||||||||
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| Practice Location | |||||||||
| Address1: | 16259 SYLVESTER RD SW | ||||||||
| Address2: | SUITE 102 | ||||||||
| City: | BURIEN | ||||||||
| State: | WA | ||||||||
| PostalCode: | 981663049 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2062425186 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/03/2013 | ||||||||
| LastUpdateDate: | 08/27/2015 | ||||||||
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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 | PT60412866 | WA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.