Provider Demographics
NPI:1063401529
Name:ILLFELDER, DANIELLE (PT, DPT, MSPT)
Entity type:Individual
Prefix:MRS
First Name:DANIELLE
Middle Name:
Last Name:ILLFELDER
Suffix:
Gender:F
Credentials:PT, DPT, MSPT
Other - Prefix:MRS
Other - First Name:DANIELLE
Other - Middle Name:LAUREN
Other - Last Name:VOLK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:263 BROUGHTON LN
Mailing Address - Street 2:
Mailing Address - City:VILLANOVA
Mailing Address - State:PA
Mailing Address - Zip Code:19085-1913
Mailing Address - Country:US
Mailing Address - Phone:617-283-0634
Mailing Address - Fax:
Practice Address - Street 1:456 SAINT DAVIDS AVE
Practice Address - Street 2:
Practice Address - City:WAYNE
Practice Address - State:PA
Practice Address - Zip Code:19087-4203
Practice Address - Country:US
Practice Address - Phone:610-225-2451
Practice Address - Fax:610-964-6166
Is Sole Proprietor?:No
Enumeration Date:2005-10-18
Last Update Date:2012-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA16101225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist