Provider Demographics
NPI:1275688806
Name:GOLDSTEIN, DANIELLE LAURIE (MPT)
Entity type:Individual
Prefix:MRS
First Name:DANIELLE
Middle Name:LAURIE
Last Name:GOLDSTEIN
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13946 BALTIMORE AVE
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20707-5000
Mailing Address - Country:US
Mailing Address - Phone:301-498-2212
Mailing Address - Fax:301-498-2213
Practice Address - Street 1:8757 MYLANDER LN
Practice Address - Street 2:
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21286-2102
Practice Address - Country:US
Practice Address - Phone:410-213-5800
Practice Address - Fax:410-213-5804
Is Sole Proprietor?:No
Enumeration Date:2007-01-24
Last Update Date:2024-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD19695225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDS429OtherBLUE SHIELD DC
MDKBXOtherBLUE SHIELD MD
MDS429OtherBLUE SHIELD DC