Provider Demographics
NPI:1285278366
Name:YORK, DANIELLE CORISSA (ATC)
Entity type:Individual
Prefix:
First Name:DANIELLE
Middle Name:CORISSA
Last Name:YORK
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:DANIELLE
Other - Middle Name:CORISSA
Other - Last Name:STERN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ATC
Mailing Address - Street 1:1425 EAST AVE
Mailing Address - Street 2:
Mailing Address - City:TURLOCK
Mailing Address - State:CA
Mailing Address - Zip Code:95380-4210
Mailing Address - Country:US
Mailing Address - Phone:209-485-4882
Mailing Address - Fax:
Practice Address - Street 1:523 GLASS LN STE 4A
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95356-9233
Practice Address - Country:US
Practice Address - Phone:209-284-1909
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-01
Last Update Date:2019-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
20000113062255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic TrainerGroup - Single Specialty