Provider Demographics
NPI:1104306216
Name:STALEY, DANIELLE (DPT)
Entity type:Individual
Prefix:
First Name:DANIELLE
Middle Name:
Last Name:STALEY
Suffix:
Gender:
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1314 WINDERMERE WAY
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:TX
Mailing Address - Zip Code:75407-6812
Mailing Address - Country:US
Mailing Address - Phone:480-521-3883
Mailing Address - Fax:
Practice Address - Street 1:851 PROFESSIONAL PARK DR
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37040-5257
Practice Address - Country:US
Practice Address - Phone:931-542-2168
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-17
Last Update Date:2025-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX13067412251P0200X
TN164212251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics