Basic Information
| Provider Information | |||||||||
| NPI: | 1740448307 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | JOHNSON | ||||||||
| FirstName: | DANIELLE | ||||||||
| MiddleName: | DUCHARME | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | PT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 804 S HUMBOLDT ST | ||||||||
| Address2: | |||||||||
| City: | SAN MATEO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 944021418 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4154201221 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1359 PINE ST | ||||||||
| Address2: | |||||||||
| City: | SAN FRANCISCO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 941094807 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4156738405 | ||||||||
| FaxNumber: | 4157718906 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/29/2008 | ||||||||
| LastUpdateDate: | 02/14/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 28324 | CA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.