Provider Demographics
NPI:1073118675
Name:BIRCH, DANIELLA MARIA (DPT)
Entity type:Individual
Prefix:DR
First Name:DANIELLA
Middle Name:MARIA
Last Name:BIRCH
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:DR
Other - First Name:DANIELLA
Other - Middle Name:MARIA
Other - Last Name:BOSBEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:PO BOX 5718
Mailing Address - Street 2:
Mailing Address - City:KALISPELL
Mailing Address - State:MT
Mailing Address - Zip Code:59903-5718
Mailing Address - Country:US
Mailing Address - Phone:406-756-0134
Mailing Address - Fax:406-309-2579
Practice Address - Street 1:3854 VILLAGE SEVEN RD
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80917-2801
Practice Address - Country:US
Practice Address - Phone:719-574-8761
Practice Address - Fax:719-574-8236
Is Sole Proprietor?:No
Enumeration Date:2020-12-01
Last Update Date:2023-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPTL0017322225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty