Provider Demographics
NPI:1215907712
Name:KOHL, DANIELLE (DPT)
Entity type:Individual
Prefix:
First Name:DANIELLE
Middle Name:
Last Name:KOHL
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:DANIELLE
Other - Middle Name:
Other - Last Name:KOHL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:510 BANK ST
Mailing Address - Street 2:
Mailing Address - City:WEBSTER CITY
Mailing Address - State:IA
Mailing Address - Zip Code:50595-2204
Mailing Address - Country:US
Mailing Address - Phone:515-832-8484
Mailing Address - Fax:515-832-5401
Practice Address - Street 1:510 BANK ST
Practice Address - Street 2:
Practice Address - City:WEBSTER CITY
Practice Address - State:IA
Practice Address - Zip Code:50595-2204
Practice Address - Country:US
Practice Address - Phone:515-832-8484
Practice Address - Fax:515-832-5401
Is Sole Proprietor?:No
Enumeration Date:2006-01-25
Last Update Date:2008-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA03473225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0486183Medicaid
IAI21675Medicare PIN