Provider Demographics
NPI:1215246913
Name:SOUCY, DANIELLE
Entity type:Individual
Prefix:
First Name:DANIELLE
Middle Name:
Last Name:SOUCY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:335 YOUNG LAKE RD
Mailing Address - Street 2:
Mailing Address - City:WESTFIELD
Mailing Address - State:ME
Mailing Address - Zip Code:04787-3211
Mailing Address - Country:US
Mailing Address - Phone:207-314-0810
Mailing Address - Fax:
Practice Address - Street 1:335 YOUNG LAKE RD
Practice Address - Street 2:
Practice Address - City:WESTFIELD
Practice Address - State:ME
Practice Address - Zip Code:04787-3211
Practice Address - Country:US
Practice Address - Phone:207-314-0810
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-29
Last Update Date:2010-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPA2979225200000X
MEMT3270225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist